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Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
e109
had complete distal migration of the FC-SEMS and were treated by
insertion of a plastic stent.
FC-SEMS completely migrated in 7 (47%) patients and could be
removed endoscopically in the remaining 8 (53%) cases. Four
patients developed a tight stricture induced by FC-SEMS at the level
of its proximal end; in one case the stricture was overcome only
after EUS-guided pancreatic rendez-vous. Follow-up is ongoing.
Results are summarized in the table.
Table
Follow-up,
mean months
n
%
(range)
Patients
15
–
–
FC-SEMS removability
8/8
100
–
Complete FC-SEMS distal migration 7/15
47
–
FC-SEMS proximal migration
1/8
12
–
MPD stricture resolution
10/15
67
–
SEMS “induced” MPD stricture
4/15
27
–
Asymptomatic
7/13*
54
15.9 (12–24)
* Two patients discontinued the follow-up (pancreatic cancer diagnosed 6 months
after stent removal, lost to follow-up.
Conclusions:
FC-SEMS removability from the MPD in chronic
pancreatitis was feasible in all cases. After a mean follow-up of
15.9 months, 54% of the patients were asymptomatic; this figure is
similar to those obtained with a single plastic stent. Occurrence of
FC-SEMS induced pancreatic strictures is a major issue and deserves
further assessment. According to our experience the use of FC-SEMS
in the MPD needs careful evaluation in the setting of clinical trials.
OC.10.6
POST-SPHINCTEROTOMY TRANSPAPILLARY BALLOON DILATION
FOR REMOVAL OF LARGE BILE DUCT STONE IS MORE EFFECTIVE
AND SAFE COMPARED TO ENDOSCOPIC SPHINCTEROTOMY?
A META-ANALYSIS
Tringali A.*, Sica M., Manta R., Mutignani M.
Ospedale Niguarda, Milano, Italy
Background and aim:
Endoscopic sphincterotomy (ES) is a useful
method for the removal of common bile duct (CBD) stones. However,
in 10-15% of patients, stone removal by ES is unsuccessful. Post-
sphincterotomy transpapillary balloon dilation (PSBD), could improve
the overall success of stone extraction with low complication rate. A
meta-analysis was conducted to estabilish the efficacy and safety of
PBSD compared to ES for removal difficult CBD stones
Material and methods:
MEDLINE, EMBASE, Cochrane Library were
searched for all articles published from 1990 until June
2015.Wefinally analyzed 6 RCTS. We included all RCTs comparison of PSBD
and ES targeting patients with CBD stones. Outcome were treatment
success or morbidity and use of mechanical lithotripsy
Results:
PSBD was effective as ES for initial stone removal (OR 1.05
95%CI 0.64-1.70) and overall success rate (OR OR 1.87 95%CI 0.53-
6.55). The use of mechanical lithotripsy was higher in the ES group
(OR 0.46, 95%CI 0.23-0.92). Complication rates were higher in ES
groups (OR 0.45 95%CI 0.29-0.70). Bleeding, rate were similar in
PBSD and ES group (OR1.50 95%CI 0.43-5.27). Pancreatitis rate was
equal in both groups (OR 0.81 95%CI 044-1.50). Perforation and
infection rates were similar in both groups (0.20 95%CI 0.04-1.71;
OR 95%CI 0.21-1.77
Conclusions:
PBSD appears to be a safe and effective method for
removal CBD stone reducing the need for mechanical lithotripsy
and overall complication while the incidence rate of pancreatitis,
bleeding, infection andd perforation were equal in both groups
OC.10.7
IMPACT OF BOWEL LAVAGE ON GUT MICROBIOTA
Drago L.
1
, Toscano M.
1
, De Grandi R.
2
, Casini V.
3
, Pace F.*
3
1
Laboratory of Clinical Chemistry & Microbiology, IRCCS Galeazzi
Orthopaedic Institute, Milan, Italy,
2
Laboratory of Technical Sciences
for Laboratory Medicine, Department of Biomedical Science for
Health, University of Milan, Milan, Italy,
3
Gastroenterologia Ospedale
Bolognini, Seriate (BG), Italy
Background and aim:
Colonoscopy is an endoscopic examination
frequently performed worldwide as screening tool. The adequate
bowel preparation is essential for a successful colonoscopy and to
date, few clear information about the impact of the bowel cleansing
on the gut microbiota exist.
Material and methods:
Design through 16S rDNA Ion Torrent
profiling of fecal samples of 10 subjects, we evaluated changes that
occurred in the gut microbiota composition immediately after the
bowel lavage and one month after the colonoscopy. We studied the
gut microbiota at phylum, class and family level.
Results:
A significant decrease in Firmicutes abundance and an
increase in Proteobacteria abundance after the colon cleansing
was observed.
g
-proteobacteria was significantly increased after
the colonoscopy, but one month after the endoscopic examination
this bacterial class was decreased 2.5 fold if compared with
baseline samples, as well as
a
-proteobacteria. Moreover, one month
after the bowel lavage a significant reduction in Rikenellaceae,
Eubacteriaceae and Lactobacillaceae abundance was observed, while
Streptococcaceae were increased 3.0 fold if compared with baseline.
Interestingly, immediately after the colonoscopy, Enterobacteriaceae
were significantly higher than baseline samples, but one month
after the colonoscopy, the abundance of this bacterial family was
significantly lower than baseline.
Conclusions:
We provide clear evidence about the impact of
bowel lavage on the gut microbiota composition. In particular,
we highlighted significant changes in the composition of several
bacterial families, up to 1 month after the colon cleansing.
OC.10.8
PREDICTION OF TECHNICAL DIFFICULTY OF COLORECTAL
ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD): PROSPECTIVE
STUDY TO FAVOR ITS PRACTICE IN THE WEST
Iacopini F.*
1
, Grossi C.
1
, Elisei W.
1
, Montagnese F.
1
, Saito Y.
2
, Andrei F.
1
,
Gotoda T.
4
, Rigato P.
5
, Costamagna G.
3
1
Endoscopy Unit, Ospedale S. Giuseppe, Albano L., Rome, Italy,
2
endoscopy Division, National Cancer Center Hospital, Tokyo, Japan,
3
Surgical Endoscopy Unit, Università Cattolica, Rome, Italy,
4
GI &
Endoscopy Unit, Tokyo University, Tokyo, Japan,
5
Pathology Unit,
Ospedale S Giuseppe, Marino, Rome, Italy
Background and aim:
Endoscopic submucosal dissection (ESD) is
indicated for the en bloc resection of gastrointestinal neoplasms
with a risk of submucosal invasion or difficult to be removed by
EMR. However, ESD is highly technical demanding, more risky than
EMR, and a stepwise model to forecast its success has not yet been
identified.
Aim:
to identify pre-, intra, and post-operative patient’s and lesion’s
features useful to predict the difficulty of ESD.
Material and methods:
Prospective study conducted in a non-
academic center by a western endoscopist with a baseline level of
competency (1). Inclusion criteria: colorectal neoplasms ≥15 or ≥20
mm with and without a scar due to previous resection/biopsies,
respectively; no features of SM-deep invasion (Kudo pit pattern type
V and/or Sano microcapillary pattern type 3B). ESD was performed
by the standard technique. The procedure was defined not difficult if
the ESD was completed en bloc and the operative speed was 13min/