144 / 172
Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
e205
of these patients and above all the clinical outcome of the chosen
treatment of the stenosis.
All the strictures were treated by endoscopic use of Savary’s dilators.
Clinical success of endoscopic treatment of the stricture was defined
as regular bowel movement and absence of re-intervention.
Results:
Of the 1548 female patients who underwent intestinal
resection for deep endometriosis (mean age 34 years old) stenosis
was observed and treated by Savary dilation in 85 patients (5.5%),
after a mean post-operative period of 90 days. A protective
colostomy was performed in 30/85 patients. No significant statistical
correlation was seen between presence of anastomotic stenosis and
stapler’s size (mean size 29), length of intervention (mean operative
time 291 minutes), resection level (mean distance from anal verge
10,3 cm), and preoperative stenosis, evaluated by barium enema
(mean preoperative stenosis mildly higher in the studied group vs
other patients: 30% vs 26%).
The number of Savary dilations was different between patients
(mean number 2 dilatations, minimum 1 and maximum 13) but
the endoscopic performances were made by the same endoscopist.
We recorded only one complication of the endoscopic treatment:
a microperforation showed by CT, treated in a conservative way. In
another patient endoscopic dilation was not effective, so we decided
for rectal stent placement.
No patients underwent a new intervention for anastomotic stenosis.
Conclusions:
Anastomotic stenosis after intestinal resection for
deep endometriosis is not a rare complication, but endoscopic
treatment by Savary dilation seems to be effective, safe and feasible.
At the moment we lack pre-operative predictive factors for this kind
of complication.
P.15.11
HIGH DOSE VERSUS NON HIGH DOSE OF PROTON PUMP
INHIBITORS IN PATIENTS WITH PEPTIC ULCER BLEEDING AFTER
ENDOSCOPIC TREATMENT: A META-ANALYSIS
Tringali A.*, Sica M., Manta R., Mutignani M.
Ospedale Niguarda, Milano, Italy
Background and aim:
Treatment with proton pump inhibitors
(PPIs) improves clinical outcomes in patients with peptic ulcer
bleeding after endoscopic treatment but the optimal dose remain
controversial. In clinical practice high dose after endoscopic
treatment are used according to International guideline. However
there are no evidence showing that high dose of PPI are superior
to non high dose. To compare the high versus non high dose of PPI
in patients with peptic ulcer bleeding after endoscopic treatment a
meta-analysis was performed.
Material and methods:
A computerized medical literature search
was performed by using MEDLINE, EMBASE, Cochrane Library,
from 1980 to March 2015, aimed at identifying available studies
that assess clinical outcomes of high vs non high dose of PPI. We
finally analyzed 11 RCTS, involving 1854 patients. Outcomes were:
rebleeding, surgery, mortality, hospital stay and blood transfusion.
Results:
There was no difference between high dose and non high
dose PPI in rebleeding rate (OR 1.3595%CI 0.93-1.97), need for
surgery (OR 1.14 95%CI 0.60-1.20) and mortality (OR 1.03, 95%CI
0.60-1.75). Hospital stay and blood transfusion were equivalent in
both group (MD 0.27 95%CI -0.44,0.98); MD 0.41;-0.22-1.03).
Conclusions:
High dose of PPI is not superior to non high PPI
in reducing rebleeding rate, need for surgery or mortality after
endoscopic treatment. Furthermore High dose did not reduce the
hospital stay or need for blood transfusion.
P.15.12
POST-POLYPECTOMY BLEEDING: RISK FACTORS AND ROLE OF
ANTIPLATELET AND ANTICOAGULANT AGENTS
Pigò F.*
1
, Manno M.
1
, Bertani H.
1
, Caruso A.
1
, Mirante V.G.
1
,
Barbera C.
1
, Rebecchi A.M.
2
, Conigliaro R.L.
1
1
Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy,
2
Ospedale
Regina Margherita, Castelfranco Emilia, Italy
Background and aim:
Post-polypectomy bleeding (PPB) is a known
adverse event that can occur following colon polypectomy in 0.3-
6.1% of cases. Several factors that depend on patient and technical
removal may impact the occurrence of PPB, but antiaggregant and
anticoagulation drugs’ assumption during polypectomy represent
still a major debate. Suspension of the drugs prevent may PPB but
arise the risk of potential ischemic events. Aim of this study was
to establish the risk factors of PPB and the role of antiplatelet/
anticoagulant drugs.
Material and methods:
15,946 medical records from 2007 to
2015 were retrospectively reviewed to find cases of immediate
(within 1 day from polypectomy) and delayed (within 15 days
from polypectomy) PPB. The control group was a cohort of patients
that underwent to consecutive polypectomy from January to April
2014. Following informations were collected: age, sex, assumption
of antiplatelet/anticoagulant drugs 5 days before and after
polypectomy, comorbidity, dimension, location and morphology
of polyps, technical of removal and use of preventive measures for
bleeding. Analysis was conducted “per patient”.
Results:
118 cases (279 polyps) and 539 controls (966 polyps)
were included in this case-control study. 50 patients experienced
immediate bleeding while 72 patients had delayed bleeding
(4 patients had both immediate and delayed). Mean time from
polypectomy to bleeding was 3.5 days. According to univariate
analysis the two groups (cases vs controls) differ for assumption of
any type of antiplatelet/anticoagulant drugs (41% vs 15%, p<0.0001),
LWMH somministration (23% vs 1%, p<0.0001), any comorbidity
(69% vs 40%, p<0.0001), number of polyps per patient (27% vs 18%,
p=0.02), dimensions > 10 mm (78% vs 33%, p<0.0001) and sessile
morphology of polyps (68% vs 82%, p=0.02). Multivariate logistic
regression analysis shown that PPB was associated significantly
with somministration of LWMH, any comorbidity and polyps with
dimensions ≥10mm. Preventive measures as clip did not reduce the
risk of PPB.
Conclusions:
PPB is mainly associated with with polyp ≥10 mm and
comorbidity of the patients. LWMH not discontinued is an important
risk factor for bleeding.
P.16 Endoscopy 2
P.16.1
FIRST NATIONAL REGISTRY ON A NEW DISPOSABLE
CHOLANGIOSCOPE FOR SINGLE OPERATOR CHOLANGIOSCOPY
Anderloni A.*
1
, Di Leo M.
1
, Mutignani M.
2
, Dabizzi E.
3
, Tarantino I.
4
,
Maselli R.
1
, Repici A.
1
1
Humanitas, Rozzano (Mi), Italy,
2
Niguarda, Milano, Italy,
3
San raffaele
Hospital, Milano, Italy,
4
ISMETT, Palermo, Italy
Background and aim:
The new single-operator cholangioscopy
(SOC) system (SpyGlass Direct Visualization System, Boston
Scientific Corp, Natick, Mass) has been designed to overcome
previous technological limitations. The aim of this study was to
describe the first reported Italian experience in the management
of biliary disease using SpyGlass DS in order to assess the technical