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Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
e209
admission, reduces timing of procedures actuation and allows a
faster and appropriate therapy.
P.16.9
DOES URGENT COLONOSCOPY FOR LOWER GASTROINTESTINAL
BLEEDING NEED ORAL BOWEL PREPARATION?
Vitale G.*, Tremolaterra F., Iosca N., Sigillito A.R.
Ospedale “San Carlo”, Potenza, Italy
Background and aim:
Acute Lower GastroIntestinal Bleeding
(LGIB) represents a quarter of all bleeding events with a progressive
increased annual incidence. Colonoscopy is recommended in the
early evaluation of LGIB. It is suggested that bowel preparation
improves endoscopic visualization, diagnostic yield and safety of the
procedure. In clinical practice, it can be difficult to perform bowel
preparation in emergencies, maybe delaying times for colonoscopy.
Material and methods:
From July 2014 to October 2015 we analyzed
retrospectively data from patients (pts) affected by LGIB undergoing
urgent colonoscopy in our Endoscopic Unit. Pts characteristics,
endoscopic diagnostic/therapeutic results and clinical outcome
were submitted to statistical analysis.
Results:
Overall, 40 pts with LGIB (F/M ratio 1:1, mean age 70
years) were included in the analysis. As expected, 65% of pts were
on antiplatelet or anticoagulation therapy. All the pts performed
colonoscopy within 24 hours.
The 77,5% of colonoscopy (31/40 pts) had a early and satisfactory
diagnostic yield. The diagnostic ability was superior for the left
colon compared to the right colon lesions (20 vs 7 lesions). In the left
colon were found 24 bleeding lesions: 6 rectal ulcers, 4 diverticula,
4 ischemic colitis, 3 post-polypectomy bleeding, 2 other colitis, 2
polyps/neoplasia, 2 radiation proctitis, 1 hemorrhoids while only 7
bleeding sources were found in the right colon (2 diverticula, 2 post-
polypectomy bleeding, 3 small bowel bleeding). Where the bleeding
source was not identified (9/40 pts; 22,5%), complete colonoscopy
after bowel preparation showed 3 right colon angiodysplasias and 2
right diverticular bleeding self-limited.
Overall, 35,5% (11/31) of pts had active bleeding endoscopically
treated (clips or clips plus epinephrine). Two pts were referred to
surgical treatment (ischemic colitis), while the other pts received
medical treatment.
Conclusions:
In our experience, peristaltic water pump cleaning
use during urgent colonoscopy without bowel preparation, is
effective in the diagnosis and endoscopic treatment of acute LGIB.
The diagnostic ability of this procedure seems to be superior for the
left colon compared to right colon lesions. This approach enables to
suggest bowel preparation and subsequent colonoscopy just to pts
with suspected right colon bleeding.
P.16.10
DOUBLE BALLOON ENTEROSCOPY IN DETECTING SMALL BOWEL
NEUROENDOCRINE NEOPLASMS (SB-NENS)
Rossi R.E.*, Branchi F., Elli L., Conte D., Massironi S.
Department of Gastroenterology and Endoscopy, Fondazione IRCCS
Ca’ Granda, Ospedale Maggiore Policlinico, and Department of
Pathophysiology and Organ Transplantation, Università degli Studi di
Milano, milano, Italy
Background and aim:
Small bowel neuroendocrine neoplasms
(SB-NENs) are usually difficult to diagnose, given their nonspecific
presentation and poor accessibility of the distal small bowel. The
diagnosis of small bowel tumors has been hugely improved with the
advent of small bowel endoscopy allowing a direct visualization of
the entire small bowel. Data describing the effectiveness of double-
balloon enteroscopy (DBE) in the detection of SB-NENs are scanty,
due to the low frequency of NENs and the still limited use of DBE in
clinical practice. Accordingly, present series was aimed at reporting
the experience at a single referral centre for NENs.
Material and methods:
All consecutive patients with a suspected
SB-NEN selected for diagnostic DBE were enrolled at our Institution.
Results:
Between January 2011 and September 2015, 45 patients
with suspected SB-NEN or affected with NEN from unknown primary
were referred to our Centre. SB-NENs were suspected on the basis of
clinical presentation, elevated neuroendocrine biomarkers and the
presence of histologically confirmed neuroendocrine metastases
(two patients), positive video capsule endoscopy (VCE) (four
patients) or positive nuclear imaging (one patient). After an extensive
work-up, six patients (4 M, 2 F, median age 50 years) underwent DBE
(three anterograde, two retrograde, one both; median time: 60 min;
median insertion 200 cm). DBE was positive in two patients with
evidence of an ileal lesion of 1 and 2 cm in diameter, respectively
(histologically G1 NEN), these findings being superimposable to
those of VCE. Both patients underwent uneventful surgical resection
of the SB-NEN. Of the four other patients with negative DBE, two
had metastatic NENs of unknown primary, one had primary jejunal
NEN revealed by Gallium68-PET and then surgically removed and
the last patient resulted a true negative as NEN was not confirmed at
long-term follow-up. Overall, in absence of falsely positive results,
DBE showed a sensitivity of 33%. No complications were observed
during the procedure.
Conclusions:
In line with data from literature, present series
showed that DBE is a safe procedure in the diagnosis of SB-NENs.
Further studies are needed to better clarify the diagnostic role of
DBE in the neuroendocrine tumor setting and its relationship with
other techniques, i.e. VCE and nuclear imaging.
P.16.11
SIMULTANEOUS ONE-PIECE ENDOSCOPIC SUBMUCOSAL
DISSECTION FOR TWO POORLY DIFFERENTIATED EARLY GASTRIC
CANCER IN ELDERLY PATIENT
Alvisi C.*, Rovedatti L., Viganò J., Broglia F., Bardone M., Strada E.,
Pozzi L., Centenara L., Antonietti M., Natoli S., Lenti M., Dionigi P.,
Corazza G.R.
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Background and aim:
Incidence of early gastric cancer (EGC)
is higher in Eastern than in Western countries and endoscopic
submucosal dissection (ESD) is actually a feasible treatment since
extended indications have been developed.
EGC presents with simultaneous multiple lesions in 5.8% to 15%
cases and only few Eastern papers describe their simultaneous
treatment with ESD.
Material and methods:
An 81 year-old woman was referred to
our unit from another hospital to treat two adjacent but separated
mucosal lesions of the antrum greater curvature. According to
the Paris Classification lesions were 0-IIa and 0-IIc, about 18mm
and 6 mm wide respectively and histological examination of
biopsy specimens showed high grade dysplasia and intramucosal
adenocarcinoma in the large one and high grade dysplasia in the
small one. Endoscopic ultrasound (EUS) described mucosal and only
first level submucosal invasion. CT scan was negative. We performed
ESD under general anesthesia using Olympus Hook-Knife (Olympus
Medical System, Tokyo, Japan).
Results:
As our video material shows, both adjacent lesions were
simultaneously completely removed in one piece. No bleeding or
other complications occurred. Every visible vessel was coagulated
with hemostatic forceps (Coagrasper Olympus Medical System,
Tokyo, Japan) and hemoclips were used for bleeding prophylaxis.
Histological examination revealed single specimen of 4.2 x 3.8
cm with 2 lesions: a 0.6cm and a 2cm lesions. Both were poorly