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Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
characteristics are resumed in table 1. Reason for a second POEM
were Eckardt score ≥ 3 after at least one balloon dilation in 17/27
(62,9%) and persistent manometric or barium swallow abnormal
findings at follow up in 10/27 (37%). Mean time interval between 1st
and 2nd POEM was 13,7 months (range 0,3-32 months). The second
POEM procedure was performed by high experienced operators. To
reduce the risk of fibrosis, a different route rather than previous
POEM access was selected. During 2nd POEM, no serious adverse
intra-procedural events were reported. In the first post-operative
day, a barium swallow and an esophagogastroduodenoscopy
confirmed the absence of mucosal injuries or procedure-related
complications. The clinical course was regular. Second POEM efficacy
as Eckardt score <3 was confirmed in 26/27 (96,3%). A woman
with persistent Eckardt score of 5 after the 2nd POEM refused to
underwent another myotomy and she were managed with repeated
pneumatic balloon dilation and clinical surveillance. Four patient
complained incomplete remission of symptoms despite eckardt <3,
reporting chest pain as more frequent discomfort.
Conclusions:
In conclusion, second POEM is a safe and effective
rescue option for recurrent achalasia in expert hands. A multi-
center study, involving a big number of patients and operators
with different levels of experience could be helpful to improve the
diffusion of second POEM.
OC.10.4
PROSPECTIVE COMMUNITY PRACTICE-BASED STUDY OF ERCP
QUALITY
Mariani A.*
1
, Anderloni A.
2
, Cengia G.
3
, Parravicini M.
4
, Cantù P.
5
,
Manfredi G.
6
, Staiano T.
7
, Amato A.
8
, Bargiggia S.
9
, Lesinigo E.
10
,
Lella F.
11
, Berni Canani M.
12
, Beretta P.
13
, Tontini G.E.
14
, Ferraris L.
15
,
Signorelli S.
16
, Lochis D.
17
, Piubello W.
18
, Segato S.
1
, Manes G.
19
,
Testoni P.A.
1
1
Ospedale San Raffaele, Milano, Italy,
2
Istituto Humanitas, Rozzano
(Mi), Italy,
3
Spedali Civili, Brescia, Italy,
4
Ospedale di Circolo e
Fondazione Macchi, Varese, Italy,
5
Ospedale Maggiore Policlinico,
Milano, Italy,
6
Ospedale Maggiore, Crema, Italy,
7
A.O. Istituti
Ospitalieri, Cremona, Italy,
8
Ospedale Valduce, Como, Italy,
9
Ospedale
Manzoni, Lecco, Italy,
10
Ospedale di Circolo, Busto Arsizio, Italy,
11
Policlinico San Pietro, Ponte San Pietro (BG), Italy,
12
Azienda
Ospedaliera, Desio e Vimercate, Italy,
13
ICCS, Milano, Italy,
14
IRCCS
Policlinico, San Donato Milanese, Italy,
15
A.O. S. Antonio, Gallarate,
Italy,
16
Ospedale Papa Giovanni XXIII, Bergamo, Italy,
17
Policlinico,
Monza, Italy,
18
A.O., Desenzano del Garda, Italy,
19
A.O. Guido Salvini,
Garbagnate Milanese, Italy
Background and aim:
Background: There are many studies and
large series about ERCP that define both the therapeutic success
and complications of this procedure, mainly performed in academic
centers. Prospective studies with data collected in a community
setting are extremely rare. This is particularly critical because the
conditions in which endoscopists act in ‘real life’ are often different
from those usually considered in controlled studies.
Aim:
The aim of this study is to assess indications, success and
complication rate of routinely-performed ERCP in a single region of
Italy.
Material and methods:
A prospective observational study on
consecutive patients undergoing ERCP in 19 hospitals of Lombardia
during a period of 6 months was performed. A centralised online
ERCP registry was built and used for data storage. The relationship
among variables related to patients, procedures and operators
were analyzed with descriptive and, when appropriate, inferential
statistics. A multivariate analysis was performed to investigate the
possible association between these variables and complications.
Results:
39 endoscopists performed a total of 2400 ERCPs of
which 2308 (96.0%) with technical success. 69 (2,9%) were purely
diagnostic procedures. Biliary-tract stone disease accounted for the
majority of the indications for the procedure (58.4%). 2183 ERCPs
(90.9%) were completed reaching the intended goal. The success rate
of the procedures was significantly related to the experience of the
operator (p=0.001). The rate of high-risk conditions and high grade of
difficulty of the procedures and the presence of an anesthesiologist
was significantly higher in centers with higher ERCP volume (p=
0.02, p < 0.001). The overall complication rate was 10%. Post-ERCP
pancreatitis (PEP) occurred in 4.3% of procedures, bleeding in 2.9%,
cholangitis in 1.4%, perforation in 0.25%. The mortality rate was 0.4%.
The incidence of PEP was not influenced by the volume of the centers
or the expertise of the endoscopists. Pancreatic duct injection
(p<0.001) and precut (p=0.03) were identified as risk factors for PEP
by multivariate analysis. The prophylaxis of PEP was performed in
19% of the cases using NSAIDS and in 2.8% by pancreatic stenting.
Conclusions:
A procedural registry was an important tool to assess
and verify the quality of routinely-performed ERCP in the community.
It gives incentives to improve the quality of this procedure and the
methods by which it is carried out.
OC.10.5
FULLY COVERED SELF-EXPANDABLE METAL STENTS TO DILATE
PANCREATIC DUCT STRICTURES DUE TO CHRONIC PANCREATITIS:
A PILOT STUDY
Tringali A.*, Landi R., Boskoški I., Familiari P., Perri V.,
Costamagna G.
Digestive Endoscopy Unit, Catholic University, Rome, Italy
Background and aim:
The endoscopic treatment for symptomatic
main pancreatic duct (MPD) strictures secondary to chronic
pancreatitis (CP) is the insertion of plastic stents obtaining stricture
resolution in near 60% of the cases. We evaluate the use of removable
fully covered, self expandable metal stents (FC-SEMS) to dilate MPD
strictures secondary to CP.
Material and methods:
Patients with CP and symptomatic MPD
stricture located in the head of the pancreas that persisted 3 months
or more after placement of a single plastic stent, were enrolled into
a prospective single arm trial. The protocol was approved from the
Ethic Committee of our University.
A Nitinol FC-SEMS (Bumpy stent, Taewoong, Korea) was inserted and
removed after 6 months. The diameter (6 or 8 mm) and length (3, 4
and 5 cm) of the FC-SEMS were chosen according to MPD diameter
and the anatomy of the stricture. Stricture resolution was defined as
a satisfactory pancreatico-duodenal contrast medium outflow and
absence of pain during continuous flushing with saline (1000 ml/
day) for 24 h through a 6 fr nasopancreatic drain positioned after
stent removal.
The primary objective was the FC-SEMS removability while
the secondary was the MPD stricture resolution rate and the
complications.
Follow-up was planned every 6 months during a 2 year period.
Pancreatic pain episodes and recurrence of pancreatitis were
recorded.
Results:
Between December 2012 and October 2014, 15 patients
(10 M, mean age 60 years) were enrolled. Pancreatic calcifications
were present in 6 (40%) and ESWL was performed in 4 (27%). Four
patients had a history of alcohol abuse. In 10 cases the FC-SEMS was
inserted through the major papilla, while 5 patients (3 pancreas
divisum, 2 dominant dorsal duct) with a prior minor papilla
sphincterotomy received the FC-SEMS through the minor papilla.
One patient developed cholangitis after 24 h due to occlusion of the
biliary sphincterotomy from the FC-SEMS; cholangitis resolved after
insertion of a plastic biliary stent.
Before the stent removal, 13 patients were asymptomatic while 2
had recurrent pancreatitis after 4 and 5 months; these 2 patients