156 / 172
Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
e217
Conclusions:
New regimen including split regimen for all subjects
undergoing colonoscopy despite scheduled time of examination
was a successful strategy in terms of quality of bowel preparation.
Further studies are necessary to identify which subgroup of subjects
showed a better improvement.
P.18.4
CLINICAL OUTCOMES OF PERCUTANEOUS ENDOSCOPIC
GASTROSTOMY IN ELDERLY PATIENTS WITH DEMENTIA
Cortelezzi C.C.*, Scardino G., Parravicini M., Rota Bacchetta G.L.,
Piana S., Bonecco S., Segato S.
UO di Gastroenterologia ed Endoscpia Digestiva Azienda Ospedaliero
Universitaria Macchi, Varese, Italy
Background and aim:
There is no clinical evidence supporting
the use of percutaneous endoscopic gastrostomy (PEG) in elderly
patients (pts) with dementia. Many studies have shown that feeding
tubes are rarely effective in improving nutrition, maintaining skin
integrity by increased protein intake, extending life or preventing
aspiration pneumonia. Despite this, PEG continues to be performed
extensively on these pts. The aim of this study was to evaluate the
clinical outcomes after placement of the PEG in elderly pts with
dementia.
Material and methods:
We evaluated retrospectively 58 pts with
dementia and more than 75 years old that underwent the placement
of a PEG during the period from 01/01/2008 to 31/12/2013. Mean
age was 85,5 years (range 75-96), 19 were male. Mean follow up was
4,5 years (range 2-7). 30 pts had vascular, 17 Alzheimer, 2 fronto-
temporal, 1 Lewy’s bodies and 8 mixed form dementia. All the pts
with advanced psycho-organic decay with low level of activities of
daily living (measured through the ADL scale) had abnormalities of
swallowing and episodes of inhalation. After PEG placement, 29 pts
lived at home and 29 in nursing homes.
Results:
We divided pts into 2 groups by age (more or less than 85
years old) and by serum albumin concentration (more or less than
3 gr/dl). We evaluated survival, complication rate, serum albumin
concentration, episodes of aspiration pneumonia (AP) at T0 (PEG
placement), T1 (6 months later) and T2 (1 year later) in 49 pts.
9 pts did not follow up. At the time of evaluations, 10 pts were
alive, 23 pts (59%) had died within a year (16,33% within a month)
and 16 (41%) after a year. The mean survival rate was 600,7 days.
There was no difference in survival rate between pts with serum
albumin concentration more or less than 3 gr/dl at the moment
of PEG placement. The incidence of AP was 51% (25/49) before
PEG placement, 16% (8/49) at T1 (p-value = 0,00048, statistically
significant) and 45% at T2 (14/31). Only 26% of pts died from
complications related to AP. The mean values of albumin levels
were 2,9 g/dl at T0, 3,2 at T1, 3,0 at T2 and there were no significant
differences.
Complication rate at T1 was 45,5% (25/55) and at T2 87,5% (28/32):
the most frequent complication was AP; there was no difference
between pts living at home or in nursing homes.
Conclusions:
In our survey, PEG placement does not improve
nutritional status in elderly pts with dementia, but allows the
maintenance of the main biochemical parameters. In the short term,
there is a reduction of aspiration pneumonia, but this trend is lost
after six months. There is no difference in the complication rate
between pts living at home or in nursing homes.
P.18.5
CLINICAL MANAGEMENT AND LONG TERM FOLLOW UP OF
PATIENTS WITH OBSCURE GASTROINTESTINAL BLEEDING AND
UNCERTAIN SUBMUCOSAL MASSES AT SMALL BOWEL CAPSULE
ENDOSCOPY
Moneghini D.*
1
, Missale G.
2
, Minelli L.
1
, Cestari R.
2
1
Chirurgia Endoscopica Digestiva Spedali Civili di Brescia, Brescia,
Italy,
2
Chirurgia Endoscopica Digestiva Università degli Studi di
Brescia, Brescia, Italy
Background and aim:
The role of small bowel capsule endoscopy
(CE) in the diagnosis of small bowel tumours (SBT) is well established.
More than 50% of SBT (neuroendocrine and mesenchymal tumours,
lymphomas) arise from small bowel extramucosal layers end their
endoscopic typical appearance is consistent with a bulge protruding
into the lumen, often indistinguishable from innocent bulges due
to prominent normal folds, intestinal loops or compressions. The
major concern for capsule endoscopist is to discriminate between
benignant and malignant bulges. The aim of this series is to report
the clinical management and the long term follow up of patients
with capsule endoscopy finding of uncertain submucosal mass.
Material and methods:
We retrospectively reviewed the charts
of 584 patients who underwent CE at Endoscopy Unit between
October 2008 and March 2015 for obscure gastrointestinal bleeding
(OGIB). Only patients in whom an uncertain bulge was described at
CE were enrolled for further analysis. Their clinical management was
reported in terms of type and number of subsequent endoscopic or
radiological procedure performed and new diagnoses obtained with
these procedures. All the patients are still following a clinical follow
up. The Given M2A video capsule system (Pillcam; Given Imaging Ltd,
Yoqneam, Israel) was used. The day before the exambowel preparation
with 2L of polyethylene glycol solution was administered. Capsule
ingestion was performed in the morning after a overnight fast.
Results:
A submucosal uncertain mass was reported in 20 of 584
patients (3.4%) referred for OGIB. The mean age was 67.1 years
(range 30-93); 14 were males. The mean follow up was 26.4 months
(range 1-72 months). Two patients were excluded from further
analysis because they are still waiting for new diagnostic procedure.
In the remaining 18 patients a total number of 25 procedures were
performed: 15 CT enterography (CTE); 7 device-assisted enteroscopy
(DAE), two second-look CE and 1MR enterography (MRE). 11 patients
had radiological procedure only; 3 patients had DAE only, 2 cases
had both endoscopic and radiological procedures, 2 patients had
radiology and CE. In 5 patients (27.8%) the presence of a submucosal
mass was confirmed by these further investigations: 2 patients had
gastrointestinal stromal tumours; 2 had neuroendocrine tumours
and 1 patient had a jejunal lipoma; in another patient (5.5%) CTE
was consistent with suspected lymphoma but the histological
confirmation was not reached. In a patient with recurrent OGIB a
duodenal Dielafoy’s lesion was found at further upper endoscopy.
In all the 11 remaining patients the follow up is free from recurrent
bleeding or cancer-related symptoms.
Conclusions:
Our results suggest that the CE finding of uncertain
submucosal mass should lead to further radiological or endoscopic
investigation because of in almost a third of the patients the suspected
submucosal mass is confirmed and is related to a neoplastic lesion.
P.18.6
ERCP OUTCOMES IN PRESENCE OF A PERIAMPULLARY
DIVERTICULUM
Mantovani N., Togliani T., Vitetta E.M., Savioli A., Troiano L., Pilati S.*
A.O. Carlo Poma, Mantova, Italy
Background and aim:
The presence of a periampullary diverticulum
(PAD) ranges from 9% to 32% of patients who undergo an ERCP;