46 / 172
Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
e107
orifice. Once the waist disappeared, the balloon remained inflated
for 60 s.
Results:
A total of 29 patients with CBD large stones were evaluated:
11 male (38%)/ 18 female (62%) with a mean age of 71.9±14.7.
Technical success (complete dilation) was reached in all patients
(100%) with a median final dilation of 15 mm in diameter: 10 mm in
4 patients (14%), 15 mm in 12 patients (41%), 18 mm in 11 patients
(38%), 20 mm in 2 patients (7%). In 6 patients (21%) EST was done
before the current procedure and DASE was performed due to stones
recurrence. In all patients but two (93%) large stones were successful
removed from the CBD (19 with retrieval balloon and 8 with aid of
mechanical lithotripsy). In those with DASE failure: 1 was treated
with intra-coledocical laser lithotripsy and 1 with surgical approach.
Only 2 early complications were recorded (7%): both mild bleeding
resolved after endoclips placement. In one patient CBD stones
recurred after 2 months.
Conclusions:
DASE after EST is an alternative, effective and safe
method for removal of CBD large stones.
OC.10.2
QUALITY EVALUATION AND PROFESSIONAL ACCREDITATION
IN DIGESTIVE ENDOSCOPY. PRELIMINARY DATA ACQUIRED
THROUGH PEER-REVIEWED SITE VISITS
Fasoli R.*
1
, Spinzi G.
2
, Torresan F.
3
, Labardi M.
4
, Merighi A.
5
,
Milano A.
6
, Riccardi L.
7
, Iannone T.
8
, Capelli M.
9
1
ASL 1 Liguria, Imperia, Italy,
2
Ospedale Valduce, Como, Italy,
3
Azienda
Ospedaliera Sant’Orsola Malpighi, Bologna, Italy,
4
Ospedale Nuovo del
Mugello, Firenze, Italy,
5
Policlinico di Modena, Modena, Italy,
6
ASL 2
Abruzzo, Chieti, Italy,
7
ASL 1 Umbria, Terni, Italy,
8
ASP Reggio Calabria,
Polistena, Italy,
9
Kiwa Cermet, Bologna, Italy
Background and aim:
Although guidelines on quality parameters
in digestive endoscopy have been implemented and widely shared,
in our country scanty data exist on their evaluation by an external
party and the efficacy of corrective interventions after a first report.
Material and methods:
With the support of Kiwa Cermet Italia
Certification Company, SIED has recently endorsed a nationwide
program of professional accreditation of endoscopy services. Based
on a handbook including a checklist to score quality items prepared
by Sied Quality Team, an array of site visits has been set up.
The first part of the project implies a first visit to spotlight
inappropriate or critical issues followed by a second visit to verify
the outcome of suggested corrective measures.
Adhesion to the protocol has been on a voluntary basis by the
involved department.
The team included: a leader (CM) dedicated to the evaluation
of general organization, two gastroenterologists (one for upper
GI evaluation, the other one for lower GI evaluation) and a nurse
dedicated to the observation of nursing and reprocessing procedures.
Results:
So far, 4 centres have been visited; in three a follow-up visit
has already been carried out, with a time lag of about 9 months.
During the first visit, the most represented critical issues were:
-Upper GI: Forrest, Los Angeles and Prague classifications; gastric
biopsies protocols.
-Lower GI: post-polypectomy surveillance; colo-rectal biopsy
protocols in inflammatory bowel diseases and chronic diarrhoea.
-Nursing management/reprocessing: pre and post procedure
registration of vital signs; Gloucester scale of post-procedure
discomfort; traceability and periodic reports on disinfection
procedures; management of histopathological reports.
Items quoted as critical/inadequate at the first visit have been
efficaciously managed in two centres, which gained professional
accreditation.
The third centre has efficaciously corrected remarks regarding
reprocessing, thanks to relevant technological improvements, but
has failed to correct most of other remarks; for these reasons, it has
not achieved accreditation.
Conclusions:
These data give a preliminary outlook concerning
most frequent critical issues in Endoscopy services. Follow-up visits
obtained satisfactory results and led to professional accreditation
in two out of three centres. These results are in part secondary to a
promising cooperation between professionals and health managers.
We look forward having more detailed data once a higher number of
site visits will be carried out.
OC.10.3
MID TERM RESULTS OF SECOND POEM FOR RECURRENT
ACHALASIA: DATA FROM A LARGE COHORT OF PATIENTS
Balassone V.*, Ikeda H., Inoue H.
Digestive Diseases Centre, Showa University Koto-Toyosu Hospital,
Tokyo, Japan
Background and aim:
Peroral Endoscopic Myotomy (POEM) is
an emerging non-incisional treatment for achalasia and for other
esophageal peristalsis disorders. Despite its efficacy is widely
reported as high (% of patients with Eckardt score ≤ 3 after POEM
ranges between 91.7-100), recurrent symptoms are reported.
Because of the relative novelty of this technique and its high efficacy,
long-term follow up results with an adequate number of patients
underwent a second POEM are still missing.
Material and methods:
We retrospectively reviewed our database
of all patients underwent a second POEM. Patient and achalasia
characteristics, peri- and post-operative data (including high-
resolution manometry, barium swallow and clinical assessment
before 1st POEM, 2nd POEM and during follow up) were therefore
collected and analyzed. Outcome measures were incidence of intra-
and post-operative adverse events for safety issues and % of patients
with Eckardt score < 3 after second POEM for efficacy.
Results:
Between August 2010 and October 2015, 27 patients under
went a second POEM for recurrent symptoms. Patient and achalasia
Table 1
Baseline characteristics of patients who underwent second POEM
Demographics
N. of patients
27
Age, median (range), y
45,8 (21-77)
Male, n. (%)
15 (55.6)
BMI, mean (range)
21,2 (14,7-37,2)
Achalasia characteristics
Duration of symptoms, mean (range), y
9,5 (0,5-32)
Type of Achalasia
†
, n (%)
I
6 (22,2)
II
6 (22,2)
III
0
Not available
15 (55,6)
Manometry IRP, mean (range), mmHg
23,4 (8-48)
Availability of IRP %
48%
Previous treatments, n (%)
Pneumatic balloon dilation
14 (51,9)
None
12 (44,4)
Heller Myotomy
1 (3,7)
Esophageal dilation
None
0
Mild
7 (25,9)
Moderate
19 (70,4)
Severe
1 (3,7)
Eckardt Score, mean (range)
6,6 (2-10)
†
According to Chicago Classification v. 3.0