Digestive and Liver Disease - Volume 48 - Supplement 2

Abstracts of the 22

National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231

e123

V.01.11

IN VIVO ASSESSMENT OF TUMOR ANGIOGENESIS IN COLORECTAL

CANCER: ROLE OF CONFOCAL LASER ENDOMICROSCOPY

De Palma G.D., Esposito D.*, Maione F., Luglio G., Siciliano S.,

Gennarelli N., Cassese G., Campione S., D’Armiento F.P., Bucci L.

AOU Policlinico Federico II, Naples, Italy

Background and aim:

Tumor neoangiogenesis is a key factor for

tumor progression and metastatic spread. The possibility to assess

tumor angiogenesis might provide prognostic information. Aim of

the study was to establish the role of probe-based Confocal Laser

Endomicroscopy (p-CLE) in the identification of vascular architecture

and specific morphological patterns in normal colorectal mucosa

and malignant lesions, during routine endoscopy.

Materialandmethods:

Fourteenconsecutivepatientswithcolorectal

cancer were included. The following features were identified and

then compared between normal and neoplastic mucosa on p-CLE

images: vessel shape (straight vs irregular); vessel diameter; the

“branching patterns”; vessel permeability (fluorescein leakage)

and blood flow (normal vs defective flux). Immunohistochemistry

was used to confirm the presence and to study the morphology

of vascular structures (CD-34 staining) and “neo-vessels” (WT-1

staining) on tumor and normal mucosa sections.

Results:

Tumor vessels appeared as irregular, ectatic and with a

highly variable caliber and branching patterns on p-CLE images.

Mean diameter of tumor vessels was significantly larger when

compared with normal mucosa (WMD, 3.38, 95% CI 2.65, 4.11,

p=0.01). Similarly, “vessel branching” (OR, 2.74, 95% CI 1.23, 6.14,

p=0.01), fluorescent dye “extravasation” (OR, 3.46, 95% CI 1.39, 8.57,

p=0.01) were significantly more frequent in colorectal cancer than

in normal colorectal mucosa. Immunohistochemistry corroborated

p-CLE findings, showing higher vascularity in tumor sections due to

neo-formed vessels, presenting irregular patterns as shown at p-CLE

images.

Conclusions:

P-CLE provides a non-invasive characterization

of the microvascular architecture of colonic mucosa. Different

morphological patterns have been described, discriminating from

normal and malignant microvascular networks in colorectal mucosa.

V.01.12

OVER-THE-SCOPE CLIP-ASSISTED ENDOSCOPIC FULL THICKNESS

RESECTION AFTER INCOMPLETE RESECTION OF RECTAL

ADENOCARCINOMA: CASE AND VIDEO REPORT

Soriani P.*

, Tontini G.E.

, Pastorelli L.

, De Nucci G.

, Steffano G.B.

Di Fratta E.

, Vecchi M.

, Lagoussis P.

Gastroenterology & Digestive Endoscopy Unit, IRCCS Policlinico San

Donato, San Donato Milanese, Milano, Italy,

Italy,

Gastroenterology

& Digestive Endoscopy Unit, AO Salvini, Garbagnate Milanese, Italy,

Italy,

Division of General Surgery I, IRCCS Policlinico San Donato, San

Donato Milanese, Milano, Italy

Background and aim:

The endoscopic resection is a valuable

therapeutic option for early colorectal cancer (CRC), especially in

high-risk surgical patients [1]. A novel endoscopic full-thickness

resection device (FTRD; Ovesco Endoscopy, Tübingen, Germany) has

been recently introduced to achieve complete resection of early CRC

during ongoing endoscopy [2].

Material and methods:

Here, we report the case of a 78-year-old

man with a history of coronary disorders and recent pulmonary

embolism who underwent colonoscopy for hematochezia. A 3 cm,

non-pedunculated colorectal polyp with adenomatous pit pattern

(Kudo IV) was observed 5 cm above the dentate line (fig.1). An en bloc

endoscopic mucosal resection was performed. Histology revealed

adenocarcinoma pT1 G2 Sm3, while total body CT scan and rectal

endoscopic ultrasound reveal no lymphatic or metastatic disease.

Based on patient’s comorbidities, we used FTRD to achieve the R0

resection (Video) after antibiotic prophylaxis with intravenous

cefalosporine.

Results:

First, lateral margins of the scarred resection site were

marked with argon plasma coagulation (fig.2). The device was

mounted on the tip of a standard gastroscope and, through a tissue

anchor, the whole scarred lesion was pulled in to the cap and the

OTSC was deployed. The pseudopolyp tissue created by the OTSC

was resected using the pre-loaded snare and standard electrosurgical

setting (VIO® ERBE Elektromedizin GmbH, Tübingen, Germany). The

procedure took about 8 minutes and no bleeding nor perforation

occurred (fig. 3). Patient reintroduced anticoagulant agents and was

discharged in perfect condition the following day. On the full-

thickness 15 mm-large specimen (fig.4), histological analysis

revealed no remnant dysplasia (fig.5), as well as in the biopsy

samples taken from the clear rectal scar 3 months later (Fig 6).

Following endoscopic ultrasound and CT scan confirmed the absence

of lymphatic or metastatic disease and abscess.

Conclusions:

This case is interesting for several reasons. First,

we have performed for the first time a full-thickness endoscopic

resection for early CRC in the distal rectum, where standard surgery

imply considerable risks and aggressive strategies. Secondly, we

evaluated the potential of the novel FTRD in a high-risk patient

with ongoing anticoagulants therapy. In addition, we have shown

in detail the long-term clinical and endoscopic outcomes of this

advanced endoscopic treatment.

References

1. Rutter MD, et al. Gut 2015;0:1–27.

2. Schmidt A, et al. Endoscopy 2015;47:719-25.

V.01.13

ENDOSCOPIC LIGATION AND RESECTION OF A LARGE

SYMPTOMATIC SUBEPITHELIAL TUMOR OF THE DUODENUM

Antonini F.*, Belfiori V., De Minicis S., Lo Cascio M., Marraccini B.,

Piergallini S., Rossetti P., Andrenacci E., Macarri G.

Ospedale A.Murri, Fermo, Italy

Background and aim:

Subepithelial tumors (SETs) are frequent

findings during endoscopy. Definitive diagnosis based on endoscopic

biopsies is often not feasible, while endoscopic ultrasonography

(EUS) is good to differentiate the nature of SET and can help guide

decisions about treatment. Surgical resection is the gold standard

for treatment of symptomatic gastrointestinal SETs, however novel

endoscopic procedures represent an alternative to surgery in

selective cases.

Material and methods:

We here report a case of a 55 years-old

woman presented for severe anemia and melena with an history

of nonsteroidal anti-inflammatory drugs use. Upper endoscopy

revealed a peduncolated SET of about 30 mm, ulcerated with

a central bleeding stigmata, located in the second part of the

duodenum. Biopsy of the lesion were inconclusive. EUS revealed