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Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
e219
Every patient was diagnosed and/or followed up with laboratory
tests (full blood count, liver-, thyroid- and kidney function, tumor
markers), genetic test, abdominal, thyroid, pelvis, testicular
ultrasonography, dermatologic, eye and otolaryngologic exam,
panoramic radiography.
Besides the endoscopic follow up, the protocol for extraintestinal
manifestations varied based on clinical and family history.
Ultrasonography of thyroid, abdomen, pelvis, testes anddermatologic
exam were repeated annually.
Results:
The cohort included 63 patients (32M, 8-80 years, median
age 32.8 years).
Fifty-nine had classic FAP, 1 Gardner Syndrome, 1 AFAP, 2 MAP.
The follow up protocol allowed to detect malignant lesions: among
classic FAPs, 1 manifested hepatoblastoma (1,7%), 3 surrenal
adenomas (5%), 3 osteomas (5%) and 4 disodontiasis (6,7%), 2 nasal
polyposis (3.4%), 7 retinal pigmented lesions (11.8%), 3 desmoids
(5%), 3 papillary thyroid carcinomas (5%), 1 testicular carcinoma
(1,7%), 1 ovarian adenocarcinoma (1,7).
The patient affected by Gardner Syndrome manifested 1
retroperitoneal neurofibroma, 1 surrenal adenoma anddisodontiasis;
among MAP and AFAP patients, none manifested malignancies.
All the lesions were detected at early stage and followed up or treated
with good prognosis, complete resolution and without relapse.
Conclusions:
FAP is a complex syndrome with multiorgan
involvement. The diagnostic and follow up protocol detected typical
and non typical associated malignancies at early stage. Further
research is requested to optimize dedicated diagnostic-therapeutic
protocols, which have to be performed in specialized tertiary care
centers.
P.18.9
ENDOSCOPIC PIECEMEAL RESECTION OF SESSILE OR FLAT
COLONIC LESIONS > 2 CM: LONG-TERM RESULTS
Bucciero F.*, Talamucci L., Naspetti R., Manetti R.
AOU Careggi, Firenze, Italy
Background and aim:
Evaluate the efficacy of endoscopic piecemeal
resection of sessile or flat colonic lesions > 2 cm.
Material and methods:
We selected all the sessile or flat colonic
lesion > 2 cm underwent endoscopic piecemeal resection.
Results:
We selected 109 sessile or flat lesions > 2 cm of 104 patients
(41 women and 63 men).
The average size of polyps was 37 mm (range 21-80 mm). 18 were
located in ceco, 16 in the ascending colon, 6 at the right colic flexure,
5 in the transverse, 2 in the left colic flexure, 3 in the descending
colon, 17 in sigmoid and 42 in the rectum.
Histological examination showed 94 adenomas tubule-villous, 2
tubular adenomas, 2 villous adenoma. High-grade dysplasia was
in 48 lesions; 9 lesions had areas of intramucosal cancer with clear
surgical margins and 2 had areas of cancer infiltrating the submucosa
and engaging margins. These last two patients underwent surgery.
Additional treatment with APC was performed in 96 of 109 lesions.
We observed a statistically significant correlation between the
presence of invasive carcinoma and the seat rectal and size > 5 cm.
Complications occurred in 13 cases: 8 bleeding treated
endoscopically, 4 perforations treated with medical therapy and 1
post-polypectomy syndrome. We observed a statistically significant
correlation between the onset of complications and the size> 5 cm
lesion.
In six cases we observed endoscopic recurrence at 3 months after
resection. After endoscopic treatment of relapse in this case no
further relapses occurred.
We observed a statistically significant correlation between the loss
of use of the APC and the onset of relapse and between the size> 4
cm and the onset of relapse.
Conclusions:
Endoscopic piecemeal resection can be considered a
valid alternative as ESD because it is a safe and simple technique,
with a low complication rate, low cost and requesting a lower
execution time.
P.18.10
SAFETY AND EFFICACY OF UNDILUITED N-BUTYL-2
CYANOACRYLATE INJECTION AS ENDOSCOPIC RESCUE
THERAPY FOR REFRACTORY ACUTE NONVARICEAL UPPER
GASTROINTESTINAL BLEEDING
Antonini F.*
1
, Rossetti P.
1
, Manta R.
2
, Piergallini S.
1
, Sica M.
2
,
Belfiori V.
1
, De Minicis S.
1
, Lo Cascio M.
1
, Marraccini B.
1
,
Andrenacci E.
1
, Mutignani M.
2
, Macarri G.
1
1
Ospedale A.Murri, Fermo, Italy,
2
Ospedale Niguarda-Ca’granda,
Milano, Italy
Background and aim:
Nonvariceal upper gastrointestinal bleeding
(NVUGIB) remains one of commonest medical emergencies
associated with a relevant proportion of refractory hemorrhage.
Novel technique, such as hemostatic powder, over-the-scope clip
and endoscopic suturing, have been recently used to treat refractory
NVUGIB. Cyanoacrylate glue (CYA) injection is an “old” technique
that has been shown to be very effective for control of variceal
bleeding, but its role in NVUGIB remains unclear. For CYA, the most
significant concern is the risk of distal embolization. Glubran 2®
(GEM; Viareggio, Italy) is a preparation of N-butyl-2 cyanoacrylate
plus methacryloxysulfolane (NBCM) with a longer polymerization
time than pure CYA and does not usually require dilution with
lipiodol. This could led to a minor rate of adverse events. Aim of this
study is to report author’s experience about the safety and efficacy of
NBCM injection for emergency control of refractory acute NVUGIB.
Material and methods:
A retrospective chart review was performed
on patients who underwent NBCM injection for severe recurrent
NVUGIB when conventional endoscopic techniques have failed. Main
outcome data for the procedure included achievement of initial
hemostasis, rate of early rebleeding (within 7 days), procedure-
related complications, and mortality.
Results:
From January 2010 to May 2015, 29 patients (19 men; mean
age 84, range 28-96) with refractory acute NVUGIB were treated
with NBCM. At the time of NBCM injection the patients were treated
previously with hemoclip placement (72.4%), local epinephrine
injection (68.9%), and argon plasma coagulation (3.4%). A bleeding
lesion was identified in the esophagus in one (3.4%) patient, stomach
in 14 (48.2%) patients, and duodenum in 14 (48.2%) patients.
Hemorrhage was secondary to 23 peptic ulcers (79.3%), 2 Dieulafoy
lesions (6.8%), 1 GIST (3.4%), 1 polypectomy (3.4%), 1 submucosal
dissection (3.4%) and 1 PEG placement (3.4%). Immediate hemostasis
was achieved in 27 patients (93.1%). Early rebleeding occurred in
two patients (6.8%); one of these was successfully treated with a
second NBCM injection. A total of 3 patients (10.3%) underwent
salvage treatment (surgery). No procedure-related adverse events
and no mortality were observed during the follow-up in any of the
patients. No instrument damage were reported.
Conclusions:
NBCMinjectionappears tobe a safe, effective, economic
and easily performed endoscopic rescue therapy for refractory acute
NVUGIB. NBCM may offer endoscopists an alternative therapeutic
strategy for severe bleeding when conventional endoscopic
techniques have failed.