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Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
success, clinical success, diagnostic yield, therapeutic yield, and
safety of the SpyGlass system for biliary diagnostic and therapeutic
procedures in tertiary care centers.
Material and methods:
The present study was a retrospective
analysis of data collected from all consecutive patients who
underwent endoscopic retrograde cholangiopancreatography
(ERCP) with SpyGlass between April 2015 and October 2015 for
biliary disease in four tertiary care centers. The components of
the modular SOC system include the disposable SpyScope (Boston
Scientific Corp) 10F access and delivery catheter with a 1.2-mm
diameter working channel, 2 dedicated irrigation channels and
4-way tip deflection for enhanced steerability. All patients were
treated under deep sedation with propofol. All the procedures were
performed by expert operators.
Results:
13 SpyGlass cholangioscopy procedures were performed
in 12 patients: 33.3% female, mean (± SD) age was 67.3 years ± 15
(range from 26 to 82 y). The indications for SpyGlass were diagnostic
(indeterminate biliary strictures) in 9 patients (4 of the common bile
duct, 1 cystic duct and 3 of the intrahepatic biliary duct, 1 PSC to
exclude carcinoma), therapeutic (stone disease) in the remaining 3
patients. 100% of the patients had undergone ERCP at least once with
sphinterotomy. In biliary strictures overall accuracy of SpyGlass for
visual and tissue diagnosis was 93% and 87%, respectively. Successful
electrohydraulic lithotripsy with stone clearance was achieved in
100% of the 3 patients who failed previous conventional therapy. One
patient received two cholangioscpoy procedures due to technical
problems with one cholangioscope. The mean (± SD) procedure time
was 37 ± 18 min (range 15 min to 60 min). No major complications
occurred during the procedure and at follow up.
Conclusions:
Our result confirmed the high diagnostic and
therapeutic success rates of SpyGlass in biliary disease. The system
demonstrated to be safe, easy to use and not time consuming in
expert hands. Further studies are needed to evaluate the diagnostic
and therapeutic yeld of cholangioscopy in biliary disease.
P.16.2
SMALL BOWEL CAPSULE ENDOSCOPY IN PATIENTS WITH LYNCH
SYNDROME. A CASE REPORT
Loiacono M.*, Castrignano V., Scotto F.
Department of Gastroenterology and Endoscopy, National Cancer
Institute, Bari, Italy
Background and aim:
Hereditary nonpolyposis colorectal cancer,
or Lynch syndrome (LS), is an autosomal dominant genetic disorder
responsible for 2-5% of all colorectal cancers (CRC), linked to DNA
mismatch repair gene defects and characterized by predominantly
right-sided CRC in early age with an increased risk for extracolonic
tumors. These include endometrial, biliary, urinary and small bowel
cancers. Small bowel tumors are rare in the general population
accounting for 1-3% of all primary gastrointestinal neoplasms. In
LS the lifetime risk of developing small bowel cancer is estimated
to to be around 4% with a relative risk of over 100 compared with
the general population. The diagnosis is often delayed because
symptoms are unspecific and tests may be inconclusive.
Video capsule endoscopy (VCE) is recommended in the suspect
of small bowel tumors when obscure gastrointestinal bleeding
and iron-deficiency anemia are not explained otherwise (strong
recommendation, moderate quality evidence).
At the present time the usefulness of VCE screening in asymptomatic
LS patients is discussed.
Material and methods:
We report the case of a LS 56-year-old
man, undergone 15 years before right hemicolectomy for a well-
differentiated adenocarcinoma of the ascending colon without
lymph node metastasis, who presented unspecific abdominal pain
and iron deficiency anemia with negative fecal occult blood test and
normal CEA value.
The patient underwent VCE after negative esophagogastroduo
denoscopy and colonoscopy.
Results:
VCE detected a metachronous jejunal tumor, which was not
reached by a following push enteroscopy. Computed tomography
scan revealed a jejunal wall thickening.
Surgical exploration confirmed a jejunal tumor which was resected.
By microscopic examination, the tumor consisted of a poorly-
differentiated adenocarcinoma with lymph node metastasis
(T3N1M0).
Conclusions:
Although VCE has not been included in guidelines
for surveillance of families with LS, its role should be considered in
selected patients with unspecific symptoms.
P.16.3
IMPROVEMENT OF APPROPRIATENESS AND REDUCTION OF
WAITING LISTS CONCERNING UPPER GI ENDOSCOPY OUT-
PATIENTS: A SINGLE-CENTRE PROSPECTIVE STUDY
Baldassarre G.
1
, Messina O.*
1
, Panozzo M.P.
4
, Tomba F.
1
, Sella D.
1
,
Ferronato A.
1
, Vanzetto E.
2
, Toffanin R.
2
, Di Mario F.
3
, Antico A.
4
,
Franceschi M.
1
1
Endoscopic Unit - Department of Surgery, ULSS 4 AltoVicentino,
Santorso (VI), Italy,
2
Department of Public Health, ULSS4 Alto
Vicentino, Santorso (VI), Italy,
3
Departments of Clinical and
Experimental Medicine, University of Parma, Parma, Italy,
4
Laboratory
Service, ULSS 4 Alto Vicentino, Santorso (VI), Italy
Background and aim:
Increasing the appropriateness of use of
upper GI endoscopy is important to improve quality of care while
at the same time containing costs. Aim of this study was to evaluate
the reduction of waiting lists concerning upper GI endoscopy out-
patients through a strict selection of endoscopy prescriptions,
Gastropanel introduction and endoscopic activity reorganization.
Material and methods:
We conducted a prospective study from July
2013 to July 2015. The upper GI endoscopy reservation was managed
by our Endoscopy Unit and all the prescriptions were evaluated
by an endoscopist. All the requests are evaluated within 24 hours.
The endoscopist evaluated if the prescription was appropriated
and decided the priority. In some cases the endoscopist could
either cancel the request or chose a less invasive examination (i.e.
Gastropanel) which evaluates serum Pepsinogen I(PGI) and II (PGII),
gastrin 17 (G17) levels and Helicobacter pylori (Hp) antibodies.
Results:
From July 2013 to July 2015 a total of 5192 upper GI
endoscopy requests were evaluated. 539 (age 50 years, range 14-
91) were judged inappropriated, 105 of which performed a upper
GI endoscopy within 2 years (range 1-22 months). The indication
of the 539 cancelled requests were: 66 cases dyspepsia, 307 cases
gastroesophageal reflux disease (GERD), 34 cases absence of written
indication, 113 cases wrong follow-up, 20 cases other. 282/539
patients were submitted to Gastropanel giving the results: 94
normal, 48 patients normal but in PPI therapy, 56 Hp infection and
30 Hp eradicated, 50 GERD, 4 atrophic gastritis. In the last 4 cases a
upper GI endoscopy was performed immediately after Gastropanel
reporting. 71/105 (67,5%) performed endoscopies were normal. No
cancer was found in upper GI endoscopies judged inappropriate.
Conclusions:
This strategy, based on a strict control of the
prescription, is effective to reduce waiting lists without any
additional public cost. The use of Gastropanel improves patient
selection for upper GI endoscopy.