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

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e100 Abstracts of the 22nd National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
time saving procedure. The aim of this study was to describe a single
center experience with the “Hot Axios” stent placement.
Material and methods: The new lumen-apposing metal stent (HOT
AXIOS, Xlumena Inc, Mountain View, Calif) is a fully covered, nitinol,
braided stent with bilateral anchor flanges. The lumen diameters
available are 6, 8, 10 and 15 mm. Clinical applications are various.
We retrospectively reviewed all consecutive patients treated with
this device in our Unit between March 2014 and October 2015.
Results: Twenty patients were treated by a single operator, with
lumen-apposing stent by EUS guided drainage. The population
cohort was composed by 9 male and 11 female, with mean age of
66.1 years (ranging from 37-95 y). The indications of EUS drainage
were: 12 pancreatic fluid collections (PFC) (2 stents with diameter
of 10 mm, 10 with 15 mm of diameter), 1 pancreatic necrosectomy
(stent diameter of 15 mm), 6 cholecystis in patients not fit for
surgery (3 with stent diameter of 10 mm, 3 with 15 mm of diameter),
1 cholangitis in patient with papilla of Vater unreachable by ERCP
(8 mm of stent diameter). All patients were treated under deep
sedation with propofol, with the linear array Olympus GF-UCT-180
series echoendoscopes in combination with the echoprocessor EU-
ME2, in a single step fluoroless procedure. The mean duration of EUS
procedure was 13.5 minutes (ranging for 10 to 25 m). All stents were
successfully positioned without complication and the mean duration
of time for stent placement was 1.8 minutes (ranging for 1 to 8).
Eighteen stents were placed transgastric, 2 transduodenal. Stent
removal was safely performed in 6 patients treated for pancreatic
fluid collection, after a median of 3,5 months. No complications
occurred during stent placement neither during stent removal.
Conclusions: EUS-guided transmural drainage with the
electrocautery-enhanced delivery system is a safe, fast, easy and
minimally invasive technique with a high technical and clinical
success rate. EUS-guided drainage is now the treatment of choice in
case of PFC, allowing their safe puncture under direct view. So far,
only ERCP dedicated devices have been adapted for this purposes.
In the last years, however, new specifically designed devices for
interventional EUS such as Hot-AXIOS™ have significantly changed
the technical approach in this setting allowing a simple, safe and
time saving procedure.
OC.08.3
DYSPEPTIC PATIENTS WITH NEGATIVE GASTROSCOPY HAVE
HIGHER PREVALENCE OF H. PYLORI INFECTION THAN PATIENTS
WITH ENDOSCOPIC LESIONS
Lahner E.*1, Esposito G.1, Hassan C. 2, Zullo A.2, Corleto V.D.1,
Di Giulio E.1, Annibale B.1
1University Sapienza, Rome, Italy, 2Ospedale Nuovo Regina Margherita,
Rome, Italy
Background and aim: In patients with dyspepsia, esophagogastro­
duodenoscopy (EGD) is often negative for visible mucosal lesions.
Routine biopsies of the normal-appearing gastric body and antrum
for the detection of H. pylori infection are not routinely obtained.
There are no clinical standards for the performance of such biopsies
of normal-appearing mucosa and diagnostic gain is conflicting. The
clinical benefit of routine bioptic sampling is still debated and recent
Kyoto guidelines suggest to consider H. pylori-related dyspepsia a
specific clinical entity, distinguished from functional dyspepsia.
The study aim was to assess the prevalence of H. pylori infection and
related gastric mucosal changes in patients with dyspepsia without
endoscopically visible lesions.
Material and methods: This post-hoc study focuses on endoscopic-
histological data from 589 patients (female 67%, median age 57 (40-
69) yrs) with dyspepsia obtained during a prospective, nationwide
study. Patients with dyspepsia as the sole indication for EGD were
included. Exclusion criteria were previous gastric surgery, severe
chronic disease, and prior treatment for H. pylori infection. All
patients underwent EGD with standard biopsy sampling to search
for H. pylori infection according to the updated Sydney System.
Clinical data were collected using a structured clinical questionnaire,
including life style items, upper gastrointestinal symptoms, and
ongoing treatments (PPIs, H2-antagonists, NSAIDs).
Results: In 349 (59.2%) of patients the gastric mucosa appeared
normal. Endoscopic lesions were present in the remaining 40.8.%,
most frequently gastric or duodenal erosions (18%) or peptic ulcer
(3.5%). Overall, 141 (23.9%) of patients were on ongoing anti-
secretory treatment.
The prevalence of H. pylori was more frequent in patients without
endoscopically visible lesions, exclusively in the corpus (36.4%
versus 25.5%, p=0.02, OR 1.67, 95%CI 1.1-2.6), while in the antrum this
prevalence was overlapping (OR 0.93; 95CI% 0.6-1.4). Precancerous
lesions as corporal atrophy and intestinal metaplasia were similar
being present in 6.1% and 6.7% in patients with endoscopically
visible lesions compared to 8.4% and 9.3% in patients without visible
lesions.
Conclusions: Dyspeptic patients with negative gastroscopy show a
nearly 1.7-fold higher probability of having H. pylori infection in the
corporal mucosa. These data highlight the need of bioptic mapping
in dyspeptic patients when gastroscopy is negative to diagnose H.
pylori-related dyspepsia.
OC.08.4
ENDOSCOPIC PAPILLECTOMY: A SINGLE ITALIAN CENTRE
EXPERIENCE
Cecinato P.*, Zecchini R., Parmeggiani F., Azzolini F., Decembrino F.,
Iori V., Tioli C., Sereni G., Cavina M., Camellini L., Sassatelli R.
Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
Background and aim: Endoscopic papillectomy (EP) has been
recognized as a safe and valuable therapeutic procedure for
ampullary adenomas that can obviate the need for potentially major
surgical intervention. This study aims to evaluate efficacy, safety and
outcome of this technique.
Material and methods: All consecutive patients who underwent
endoscopic papillectomy because ampullary tumor at Arcispedale
Santa Maria Nuova (Reggio Emilia, Italy) between January 1992
and December 2014 were considered; only patient with diagnosis
of ampullary adenoma on the endoscopic resection specimen were
included in the analysis.
The primary outcome of the study was the technical success of the
papillectomy.
The secondary outcomes were the incidence of adverse events, the
incidence of recurrence, and the comparison of these outcomes
between patients with sporadic ampullary adenomas (SAA) and
patients with FAP-associated ones.
Technical success was achieved when the following criteria were
met: a) complete removal, even in multiple sessions, confirmed by
the absence of residues at histology at the first follow-up; b) the
absence of recurrence in the follow-up.
Technical failure was defined when at least one of the following
criteria was met: a) histology> pT1; b) residual adenomatous tissue
not suitable of endoscopic resection; c) recurrence: the presence
of adenomatous tissue, confirmed by histology, after at least one
negative control after papillectomy.
Results: 59 patients were enrolled: 22 FAP and 37 SAA. Technical
success was achieved in 24 patients (40.6%): 10 (45.4%) FAP and 14
(37.8%) SAA.
Mortality was 0% and morbidity 9/59 (15,2%) included bleeding in 4
patients, and 5 patients had acute pancreatitis.
During follow-up 23 (39%) patients had recurrence: 11 FAP (50%)
and 12 SAA (32.5%). 6 patients (10.2%) were referred to surgery for