Digestive and Liver Disease - Volume 48 - Supplement 2

e208

Abstracts of the 22

National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231

The seat of stents was: 33 in rectum, 29 in sigmoid, 14 in descending,

7 at the level of the left flexure, 6 in the transverse, 1 at the right

colic flexure.

89 of 90 stents were not covered and one partially covered; 87

N-type and D-stent-stent (Taewoong Medical), 1 and 2 type Wallflex

Ultraflex (Boston Scientific).

Technical success was achieved in 90/90 patients (100%), while the

clinical success was achieved in 88/90 patients (97.8%).

Early complications (within 72 hours) were 2 dislocations of the stent.

Late complications (after 72 hours) were represented by two cases

of ingrowyh tumor 10 months after the procedure and one case of

dislocation after about six months.

In none of the patients in which the stent has been positioned as a

“bridge to surgery” it has been necessary to pack a stoma protection

during surgery.

Conclusions:

SEMS use is considered a therapeutic alternative to

surgery in the treatment of neoplastic stenosis of the colon.

In patients with neoplastic disease in advanced stage or where

surgery is contra-indicated, endoscopic therapy may be palliative.

In the case of intestinal obstruction tumors amenable to surgery, the

goal of stenting is to enable the ideal timing of surgery definitive,

reducing the high rate of morbidity and mortality related to surgery

in emergency.

P.16.7

WIRELESS CAPSULE ENDOSCOPY FOR THE DIAGNOSIS OF

OBSCURE GASTROINTESTINAL BLEEDING IN VON WILLEBRAND

DISEASE: A RETROSPECTIVE CASE SERIES

Ferretti F.*

, Branchi F.

, Tomba C.

, Conte D.

, Siboni S.M.

Biguzzi E.

, Elli L.

Center for the Prevention and Diagnosis of Celiac disease,

Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’

Granda Ospedale Maggiore Policlinico, Milan, Italy,

Department of

Pathophysiology and Transplantation, Università degli Studi di Milano,

Milan, Italy,

Angelo Bianchi Bonomi Hemophilia and Thrombosis

Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico,

Milan, Italy

Background and aim:

Von Willebrand disease (VWD) is the most

common inherited bleeding disorder characterized by deficiency/

dysfunction of von Willebrand factor. Recurrent gastrointestinal

bleeding is a severe manifestation, mainly related to angiodysplasia.

In these patients, diagnosis and management of obscure bleeding

is challenging, often requiring hospitalization. A recommended

diagnostic and therapeutic management has not been codified

yet. In particular, the role of capsule endoscopy (CE) needs further

validation.

Material and methods:

Among 675 subjects affected by VWD

and followed at the A.B. Bonomi Hemophilia and Thrombosis

Center, we retrospectively collected data about patients affected by

obscure recurrent GI bleeding referred to our Gastroenterology and

Endoscopy Unit for small bowel evaluation between January 2010

and June 2015. Demographic data, VWD natural history, diagnostic

tests, treatment and clinical follow-up were analyzed.

Results:

Six patients (3 F; median age 66 years, range 48-81)

underwent CE to investigate anaemia in recurrent GI bleeding. They

were affected by type 1 VWD (2 patients), type 2A (2), type 2B (1),

type 3 (1). Overall, 9 procedures were performed; seven positive

findings were detected: small bowel angiodysplasia (3 patients, one

with active bleeding), bright red blood in small bowel lumen (2)

and in stomach (2). Anterograde double-balloon enteroscopy was

performed to successfully treat the active bleeding. Argon plasma

coagulation and clipping were applied. The other patients were all

conservatively managed with VWF/FVIII concentrate, tranexamic

acid, oral iron and blood transfusions. In 2 cases, secondary long-

term prophylaxis with VFW/FVIII concentrates was started to

prevent new bleeding episodes. Surgical resection and second-line

treatments such as hormonal therapy or thalidomide were not

necessary in any case.

Conclusions:

Obscure gastrointestinal bleeding is a challenging

complication in VWD. Endoscopic procedures such as capsule

endoscopy and double balloon enteroscopy seem to be a successful

and well-tolerated tool to diagnose and treat small bowel bleeding.

However, the effectiveness highly depends on the timing of

procedure and the presence of active bleeding. A positive finding can

crucially modify the management of the patient, usually requiring a

multimodal therapeutic approach.

P.16.8

UTILIZATION OF OBSERVATION UNIT IN EMERGENCY

DEPARTMENT FOR THE FINDING OF OBSCURE

GASTROINTESTINAL BLEEDING THROUGH CAPSULE ENDOSCOPY:

A PILOT STUDY

Riccioni M.E., Petruzziello C., Del Prete A., Tortora A., Sinatti D.,

Costamagna G., Gasbarrini A., Franceschi F., Ojetti V.*

Università Cattolica del Sacro Cuore, Roma, Italy

Background and aim:

Overcrowding and hospital admission is a

serious and ongoing challenge in Italian emergency departments

(EDs), due to the continuous constriction of beds in the hospitals.

As a consequence, brief observation units (BOU) have been intro

duced in Italian EDs, aimed at reducing inpatient hospital admission

by allowing rapid access to diagnostic techniques and therapy.

Gastrointestinal (GI) bleeding is one of the causes of admittance to

EDs, and obscure gastrointestinal bleeding (OGIB) remains a major

clinical challenge since it usually requires hospital admission.

The scene was revolutionized by the availability of the capsule

endoscopy (CE), which is noninvasive and well tolerated by patients.

ED-based short-stay units can lessen ED overcrowding by influencing

outcomes such as ED wait times and hospital costs.

The aim of our study was to assess the feasibility of a new approach

based on performing CE directly from BOU instead of inpatient

hospital admission, thus reducing hospitalization.

Material and methods:

We enrolled 19 (6M/13F; mean age 60.5

+- 11 years) consecutive patients accessing our ED from July 2014

to July 2015, with both upper and lower gastrointestinal endoscopy

with negative results and with an active gastrointestinal bleeding

and/or a significant sideropenic anemia (Hb lower than 9 gr/dl).

All patients where admitted to the BOU, and underwent CE with

the PillCam capsule endoscopy system (Given Imaging, Yoqneam,

Israel), according to the standard protocols.

A positive CE was defined as the presence of CE findings that may

account for the clinical bleeding (angiodysplasia, ulcers or erosions,

tumor, Crohn’s disease, and active bleeding with no identifiable

source), whereas a negative CE was defined as the absence of

abnormalities on CE.

Results:

84% (16 out of 19 pts) resulted positive to OGIB.

Eight showed angiodysplasias, 1 colon diverticulosis actively bleed

ing, 1 ileal erosion from drug abuse, 1 duodenum-ileal ulcers, 1

suspected Meckel’s diverticulum, 1 erosive gastroduodenitis, 1

duodenal neoplasia, 1 Gastrointestinal Stromal Tumor and 1 active

bleeding in the jejunum.

The day after the CE pts were submitted to enteroscopy for endo

scopic treatment.

All patients were finally discharged, while only 2 were referred for

emergency surgery.

Conclusions:

Performing CE in patients with OGIB in BOU instead

of hospital admission is feasible and cost effective, since the

daily cost of BOU is 275 Euro compared to 1000 Euro of regular

hospital admission. This approach decreases unnecessary inpatient