Digestive and Liver Disease - Volume 48 - Supplement 2 - February 2016

154 / 172

Abstracts of the 22nd National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231 e215
wehere this technique was developed more than 10 years ago. In
East countries the training curve is done on gastric GI lesions with
expert supervision before starting on esophageal and colon lesions.
In West countries EGC is a rare desease and expert guidance is not
commonly available, so the learning courve of this tecnhique has to
be developed in a different way. Aims: To demonstrate that the ESD
learning curve performed on rectal lesions is a good way to practice
on these difficult procedures in European countries.
Material and methods: We retrospectovely included in the study all
the ESD performed in our Endoscopy Unit in Padua from February
2012 to April 2015 on 10552 colonoscopies. None neplastic lesions
come frome other endoscopy units. We considered the learning
curve of a single dedicated endoscopist that before starting on
humans performed 10 ESD on in vivo animal models under expert
guidance. All the dissections were performed using Hybridknife
needle and ERBEJET2(ERBE®). Complications after procedure were
managed with hemoclips, OTSc clips and hemostatic forceps. ESD
was performed if the neoplastic lesion was considered susceptible
to ESD regardless to the size. T test for unpaired data and Pearson
chi-test were used for ststistical analysis.
Results: 48 ESD were performed, 27M(56%) and 21F(44%), mean age
63yr. 31 rectum (64%), 12 sigmoid tract (26%), 1 trasverse colon (2%),
4 ascending colon (8%). The neoplastic lesions were: 35 laterally
spreading tumors (73%), 5 polipoid lesions 0-Is (11%), 4 recurrent
tumor on scar (8%), 4 polipoid lesion 0-Isp (8%). Mean polyp area
was 13,74 cm2 (range 1-70). Mean intervention time 99 min (range
20-240). En-bloc dissection was successful in 33/48 (68%) and R0
was reached in 24/33 (72%). Polyps hystological features were:
10 LGD (20%), 27 HGD (57%), 6 pT1 (17%), 3 pT2 (6%). Procedural
complications accurred in 13/48 (27%): perforation in 9/48(18%),
delayed bleeding 2/48(4%), rectal stenosis 2/48(4%). No deaths
or surgical interventions followed the procedural complications.
From the 12th procedure onwards the en-bloc performance became
acceptable 22/27(81%) vs 3/12(25%) (p<0,001). From the 30th
procedure onwards the en-bloc performance became good 17/18
(94%, p<0,001) and the mean execution time was significantly lower
55 vs 122 min (p<0.0001) with no significant difference in the mean
area of the lesions 16,6 vs 18,2 cm2 (p=ns).
Conclusions: In our experience to reach an acceptable confidence
with ESD procedure starting the training from in vivo animal model (at
least 10 procedures) and then to colo-rectal neoplasms (no size limit)
no less than 12 procedures had to be performed, but we still probably
havent yet reached the learning curve plateau also after 40 procedures.
P.17.9
VIDEOCAPSULAR ENDOSCOPY IN OCCULT OBSCURE
GASTROINTESTINAL BLEEDING: REPORT OF FIVE YEARS
EXPERIENCE OF A REFERRAL TERTIARY CENTRE
Girardin G.*, Bartolo O., Ugoni A., D’Inca’ R., Galeazzi F.,
D’Odorico A., Buda A., Sturniolo G.C., Savarino E.V.
Dpt of Oncological, Surgical and Gastroenterological sciences, Padova
University Hospital, Padova, Italy
Background and aim: Gastrointestinal bleeding is still a frequent
challenge in daily practice and one of the most frequent issue
requiring specialist evaluation. It is defined occult when the bleeding
is not visible, and obscurewhen both oesophagogastroduodenoscopy
(OGDS) and colonscopy (CS) are negative for lesions or potential
source of bleeding. Videocapsule endoscopy (VCE) is the first choice
in the evaluation of patients with obscure occulte gastrointestinal
bleeding (OOIGB). The aims were to report a five years of experience
in a tertiary referral centre for VCE in case of OOIGB and to identify
whether factors exists, able to predict presence of lesions at VCE.
Material and methods: Consecutive patients with OOIGB from 1st
of January 2010 to 31st December 2014 were included. A systematic
register for VCE was created in 2010 including demographic and
clinical data of patients, indication to VCE and endoscopic findings.
Results: Out of 1159, 412 VCEwere performed for OOIGB. Particullary,
there were 209 male patients with a median age of 67.04+/-15.48
yrs, and 203 female pts with a median age of 63.78+/-15.48yrs. 176
(43%) pts were taking NSAIDs, anticoagulant or antiplatelet agents.
Basal hemoglobine (Hb) was 8.62+/-1.82 g/dL. 10 examinations
(2,4%) were incoplete, 146 (35,2%) were negative for lesions,256
were positive, whom 43 (10,4%) with active bleeding. Not bleeding
lesions detected by VCE were: 107(25,9%) angiodysplasia, 59(14.3%)
ulcers, 18(4.3%) polyps, 13(3.2%) ulcers and angiodysplasia, 9(2.2%)
petechiae, 4(0.97%) cancer and 3(0.7%) signs of portal hypertention.
In case of bleeding active source was identified in 24 cases (55,8%),
mostly angiodysplasia (37,2%) and ulcers (13.9%). Among these
latter pts 16(39%) were taking NSAIDs or anticoagulant/antiplatelets
agents. At univariate analysis, there was no difference between pts
with a positive and negative VCE for gender, age, mean basal value of
Hb, NSAIDs and anticoagulant/antiplatelets agents.
Conclusions: VCE is usefull but not exhaustive method for
identification of bleeding or lesions in OOIGB, identifying lesions
in 2/3 of performances: in 10% of cases it is able to identify lesions
previously missed by OGDS and CS. However, we failed to predict the
results of VCE based on clinical features of the patients at baseline.
P.18 Endoscopy 4
P.18.1
SMALL BOWEL TUMORS IN PATIENTS UNDERGOING CAPSULE
ENDOSCOPY: A SINGLE CENTER EXPERIENCE
Moneghini D.*1, Missale G.2, Minelli L.1, Cestari R.2
1Chirurgia Endoscopica Digestiva Spedali Civili di Brescia, Brescia,
Italy, 2Chirurgia Endoscopica Digestiva Università degli Studi di
Brescia, Brescia, Italy
Background and aim: Small bowel tumors (SBT) are a rare disease
but their incidence is increasing. Until recently, the diagnosis of
SBT is difficult and often delayed. Video capsule endoscopy (CE)
seems to be the ideal tool for diagnosis of SBT; however, the data
from clinical studies are different in terms of diagnostic yield,
clinical and pathological features. The aim of this study is to report
a single center experience regarding small bowel tumors in patients
undergoing capsule endoscopy in order to analyze the clinical items,
endoscopic findings and clinical management of these patients.
Material and methods: We retrospectively analysed the charts of
606 consecutive patients who underwent CE (Pillcam Given M2A
video capsule system; Given Imaging Ltd, Yoqneam, Israel) between
October 2008 and November 2014 in order to identify those with
CE findings consistent with SBT and subsequent histological
confirmation. Capsule ingestion was performed in the morning after
a overnight fast. The day before the exam bowel preparation with 2L
of polyethylene glycol solution was administered. All the patients
gave their written informed consent.
Results: Of 606 patients undergoing CE, 17 (2.8%) had primary
SBT; 13 (76.5%) were males, with a mean age of 69.7 years. Among
these patients, indications for CE were obscure gastrointestinal
bleeding (OGIB) in 14 (82.3%, overt type and occult type in same
proportion); follow up of Peutz Jeghers syndrome in 1; radiological
suspect in 1 and Octreoscan suspect in 1. The main SBT type found
was adenocarcinoma (7 cases, 41.2%); followed by carcinoid (29.4%)
and gastrointestinal stromal tumor (GIST) in 29.4%. No secondary
SBT were found. Capsule retention occurred in a single case (5.9%),
without onset of symptoms; in this case the capsule was retrieved