Digestive and Liver Disease - Volume 48 - Supplement 2

e210

Abstracts of the 22

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

differentiated adenocarcinoma (PDA) with signet-ring cells (SRC)

cancer component (PDA was predominant), no lymphatic or

vascular invasion was detected, depth of submucosal invasion was

< 500 micron, vertical and horizontal margins were negative and

there was no ulceration. Given the patient’s age and histological

criteria that met expanded indications for endoscopic resection

(ER), after multidisciplinary discussion ESD was considered curative

and scheduled a 3-month follow up.

Conclusions:

EGC diagnosis is more common in Eastern (70%) than

in Western (15%) countries and histologically undifferentiated-type

is less common than differentiated-type. Only very recently have

European guidelines shared the expanded indications for ER of the

Japanese guidelines.

In conclusion, simultaneous ESD (same day- one piece-same time)

for synchronous EGC was a feasible and safe option for our elderly

patient. The single procedure for the two EGC reduced hospital stay,

avoided patient risks and discomfort, with lower costs compared

with separate procedures. To our best knowledge, in Western

countries no papers have dealt with “one piece en bloc ESD “ for

simultaneous resection of two poorly differentiated adjacent but

separated EGC in elderly patient.

P.16.12

CAP-ASSISTED MUCOSECTOMY OF COLORECTAL LESIONS:

EXPERIENCE OF 59 CASES BY THE GASTROENTEROLOGY AND

ENDOSCOPY UNIT – TRENTO

Agugiaro F.*, Franceschini G., Decarli N.L., Pertile R., De Pretis G.

Ospedale Santa Chiara, Trento, Italy

Background and aim:

CAP-assisted endoscopic mucosal resection

(C- EMR) is a well codified procedure to treat superficial esophageal

and gastric lesions (also reported in the technical file of the device).

However the use of these techniques for the resection of colorectal

lesions is not regulated. There are few studies on C-EMR for

colorectal lesions and few centers perform this type of technique.

The main limitation of the use of CAP in colonic lesions is the

increased risk of entrapment of the muscle layer in the loop with

secondary perforation.

The advantages are a better view of the lesion, the opportunity to

remove lesions in difficult sites and to obtain deeper histological

sample.

The Gastroenterology and Endoscopy Unit of Trento performs C-EMR

since many years, not only for upper gastrointestinal lesions but also

for colorectal lesions.

The main aim of the present study was to evaluate usefulness,

effectiveness and safety of C-EMR in the treatment of colorectal

lesions, compared to piecemeal resection.

Material and methods:

we retrospective collected all C- EMR for

colorectal lesions performed at the Gastroenterology and Endoscopy

Unit of Trento, between January 2012 and September 2014.

The results were compared with a control group rapresented by the

endoscopic piecemeal resection of colorectal lesions larger than 20

mm performed during same period.

Results:

59 lesions underwent C-EMR.

41 were lateral spreading tumours (69%) and 18 sessile polyps (31%).

Complications were recorded in 4 cases (6.8%): 1 “early” bleeding,

2 “delayed” bleeding and 1 “early” bleeding + perforation. None of

them underwent surgery.

Post procedure follow up was available in 47 lesions with a median

of follow-up of 10 months (range 2-28). Disease recurrence was

described in 9 cases (19%).

Complications and recurrence rate were compared with the control

group (47 piece-meal removed lesions). No differences between the

two groups were not statistically significant (complication rate: 6.8%

vs 2.1%, p: 0.26; recurrence rate: 19% vs 32.5%; p: 0.07).

Conclusions:

The present study shows that the efficacy and safety

of C-EMR of colorectal lesions is comparable to the piecemeal

resection.

Furthermore C-EMR is characterized by a better visualization of

the lesions allowing treatment in difficult sites and by deeper

histological sections.

P.16.13

THE INCIDENCE OF POST-ERCP PANCREATITIS IS NOT REDUCED

IN PATIENTS GIVEN INTRAVENOUS KETOROLAC FOR POST-

PROCEDURAL ABDOMINAL PAIN

Le Grazie M.*

, Mariani A.

, Di Leo M.

, Maini A.

, Testoni P.A.

Ospedale San Raffaele, Milano, Italy,

Ospedale San Secondo, Fidenza,

Italy

Background and aim:

Non-steroidal antiinflammatory drugs

(NSAIDs) such as indomethacin and diclofenac, administered

rectally, are effective in reducing post-ERCP pancreatitis (PEP).

This effect seems lost when they are injected intramuscularly or

intravenously. The aim is to assess whether intravenous ketorolac

given as an analgesic to patients with post-procedural abdominal

pain reduces the rate of PEP.

Material and methods:

We retrospectively evaluated all hospital

in-patients who had undergone therapeutic ERCP in a one-year

period, comparing the rates of PEP in those who developed post-

ERCP abdominal pain and those who did not. Patients with pain

received ketorolac as analgesic NSAID (group A), patients without

pain did not (group B). Patients with post-ERCP abdominal pain who

were given ketorolac were also compared with those treated with

non-NSAIDs because of contraindications.

Results:

A total of 587 patients underwent ERCP: 277 had post-

procedural abdominal pain (47%), 310 had none. Among patients

with pain, the rates of PEP were 7.8% for those given ketorolac and

8.5% for those taking non-NSAIDs (p=0.79). Comparing groups A and

B, the rates of PEP were not significantly different considering both

all the patients (respectively 7.8% and 4.2%, p=0.08) and those at

high risk (3.8% and 6%, p=0.6). In multivariate analysis, age was the

only factor significantly associated with PEP (p=0.03); ketorolac was

not (p=0.16).

Conclusions:

Intravenous ketorolac to patients with post-ERCP

abdominal pain seemed not to reduce the rate of PEP in either

the whole group or in patients at high risk for this complication,

compared to patients with no post-ERCP pain and no treatment.

P.16.14

BILIARY FULLY COVERED SELF EXPANDABLE METAL STENTS:

EXPERIENCE IN A SINGLE CENTER

Occhipinti P.*, Orsello M., Armellini E., Ballarè M., Crinò S.F.,

Montino F., Saettone S., Tari R., Colombo M.

Azienda Ospedaliero Universitaria “Maggiore della Carità”, Novara,

Italy

Background and aim:

Fully covered self-expandable metal stents

(FCSEMS) have been used for the management of malignant biliary

strictures as well as non malignant various biliary conditions

including fibrotic distal bile duct stenosis, difficult choledoco-

lithiasis and post-sphincterotomy bleeding. We describe a series

of fully covered self expandable metal stents displaced for the

treatment of different diseases involving the common bile duct in

a single center. Feasibility, short and long term efficacy and adverse

events were evaluated.

Material and methods:

We retrospectively reviewed all the patients

treated in the period between January 2014 to june 2015, receiving

a fully covered self expandable metal stent as first choice procedure