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

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e68 Abstracts of the 22nd National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
(75%) months. PM was planned at three months interval or at stent
dysfunction in 94% of the Units. During PM, removal of all stents
at each procedure and progressive increase of stents was the
preferred option, using short guidewire technique in 35% of Centers.
Duration of endotherapy was planned until radiological resolution
of the stricture in the majority of the Centers. During follow-up MR
cholangiography at three or six months was generally used.
5. Recurrent AS was treated endoscopically in 83% of Centers, by PM
in 44% or crossing-over endotherapies in 28%, i.e. PM if fully covered
SEMS failed as first line treatment or viceversa.
Conclusions: In Italy, most Endoscopic Units which Liver
TransplantationCentersrefertoarehighvolumeonesandtheworkload
dedicated to AS is substantial. Selection criteria for endotherapy are
homogeneous among Centers. Progressive plastic multistenting is
the preferred option for first and second line endoscopic treatment
although use of fully covered SEMS is not negligible.
PC.01.2
PREDICTIVE VALUE OF THE “DICA” ENDOSCOPIC CLASSIFICATION
ON THE OUTCOME OF THE DIVERTICULAR DISEASE OF THE
COLON: AN INTERNATIONAL STUDY
Tursi A.*1, Brandimarte G.2, Di Mario F.3, Annunziata M.L.4,
Bafutto M.5, Bianco M.A.6, Colucci R.7, Conigliaro R.8, Danese S.9,
De Bastiani R.10, Elisei W.11 , Escalante R.12, Faggiani R.13, Ferrini L.14,
Forti G.15, Latella G.16, Graziani M.G.17, Oliveira E.18, Papa A.19,
Penna A.20, Portincasa P.21, Søreide K.22 , Spadaccini A.23, Usai P. 24,
Zampaletta C.13, Cassieri C.2, Desserud K.F.22, Di Cesare L.2,
Fiorella S.23, Landi R.19, Lecca P.G.2 , Goni E.3, Lai M.A.24, Pigò F.8,
Rotondano G.6, Schiaccianoce G.21, Scarpignato C.25, Picchio M.26
1Gastroenterology Service, ASL BAT, Andria (BT), Italy, 2Division
of Internal Medicine and Gastroenterology, “Cristo Re” Hospital,
Roma, Italy, 3Department of Clinical & Experimental Medicine,
Gastroenterology Unit, University of Parma, Parma, Italy, 4Division
of Gastroenterology, IRCCS “San Donato”, San Donato Milanese (MI),
Italy, 5Istituto Goiano de Gastroenterologia e Endoscopia Digestiva
Ltda, Goiânia, Goiás, Brazil, 6 Division of Gastroenterology, “T. Maresca”
Hospital, Torre del Greco (NA), Italy, 7Digestive Endoscopy Unit,
“San Matteo degli Infermi” Hospital, Spoleto (PG), Italy, 8Division of
Digestive Endoscopy, “Sant’Agostino Estense” Hospital, Baggiovara
(MO), Italy, 9IBD Unit, IRCCS “Humanitas”, Rozzano (MI), Italy,
10Service of Territorial Gastroenterology, Feltre (BL), Italy, 11Division
of Gastroenterology, ASL RMH, Albano Laziale (Roma), Italy, 12Loira
Medical Center, Universidad Central de Venezuela, Caracas, Venezuela,
Bolivarian Republic of, 13Division of Gastroenterology, “Belcolle”
Hospital, Viterbo, Italy, 14Service of Gastroenterology and Digestive
Endoscopy, “Villa dei Pini” Home Care, Civitanova Marche (MC), Italy,
15Division of Digestive Endoscopy, “S. Maria Goretti” Hospital, Latina,
Italy, 16Division of Gastroenterology, “S. Salvatore” Hospital, University
of L’Aquila, L’Aquila, Italy, 17Service of Digestive Endoscopy, “S. Camillo”
Hospital, Roma, Italy, 18Department of Surgery, Federal University
of Goiás, Goiânia,Goiás, Brazil, 19Division of Internal Medicine and
Gastroenterology, C.I.“Columbus”, Catholic University, Roma, Italy,
20Division of Gastroenterology, “S. Paolo” Hospital, Bari, Italy, 21 Medical
Clinic “A. Murri”, A.O.U. Policlinico, Bari, Italy, 22Department of
Gastrointestinal Surgery, Stavanger University Hospital, University
of Bergen, Stavanger, Norway, 23 Division of Gastroenterology and
Digestive Endoscopy, “Padre Pio” Hospital, Vasto (CH), Italy, 24Division
of Gastroenterology, “Monserrato” University Hospital, University of
Cagliari, Cagliari, Italy, 25Laboratory of Clinical Pharmacology, Division
of Gastroenterology, University of Parma, Parma, Italy, 26Division of
Surgery, “P. Colombo” Hospital, ASL RMH, Velletri (Roma), Italy
Background and aim: The endoscopic classification DICA
(Diverticular Inflammation and Complication Assessment) has been
recently developed for patients suffering from diverticulosis and
diverticular disease. The aim of this study was to assess its predictive
value on the outcome of the disease.
Material and methods: We reassessed retrospectively patients
in whom endoscopic videos and/or photos and clinical follow-up
were available. For each patient, we recorded: age at the time of
disease occurrence; severity of DICA (grade 1, 2 or 3) at the time of
diagnosis; months of follow-up; therapy taken during the follow-
up; occurrence/recurrence (in months) of diverticulitis.
Results: The study enrolled 1651 patients (793 M, 858 F, mean age
66.6 ±11.1 years): 939 (56.9%) patients were classified as DICA 1, 501
(30.3%) as DICA 2 and 211 (12.8%) as DICA 3. The mean follow-up
was 29.5±28.7 months. Acute diverticulitis (AD) occurred/recurred
in 263 (15.95) patients; surgery was necessary in 57 (21.7%) of those
cases.
DICA was the only factor significantly associated to the occurrence of
diverticulitis (p<0.0001) and surgery (p<0.0001) either at univariate
or multivariate analysis. At each level of DICA classification a
significant increase of diverticulitis occurrence was detected
(hazard ratio (95% CI): DICA 1 vs DICA 3: 18.992 (12.267 to 29.406);
p<0.0001) (figure).
Therapy with various regimens was taken by 869 (52.6%) patients
during the follow-up. With respect to prevention of occurrence/
recurrence of diverticulitis, assumption of therapy was effective
only in DICA 2 patients with HR (95% CI) of 1.796 (p=0.002). In those
patients, therapeutic regimens including mesalazine were the only
effective therapies to reduce diverticulitis occurrence/recurrence
compared to no therapy (HR (95% CI) vs no therapy: 0.2103 (0.122
to 0.364), p<0.0001.
Conclusions: DICA classification is a valid parameter to predict the
risk of diverticulitis occurrence/recurrence in patients suffering
from diverticular disease of the colon.
PC.01.3
KNOCKDOWN OF SMAD7 WITH MONGERSEN ATTENUATES
COLITIS AND COLITIS-DRIVEN FIBROSIS IN MICE
Izzo R.*, Marafini I., Monteleone I., De Simone V., Colantoni A.,
Ortenzi A., Bevivino G., Monteleone G.
University of “Tor Vergata”, Rome, Italy
Background and aim: In Crohn’s disease (CD), tissue-damaging
immune response is associated with high Smad7, an inhibitor of
TGF-b1 signaling. Smad7 inhibition with Mongersen, a specific
antisense oligonucleotide, restores endogenous TGF- b1 activity
leading to inhibition of inflammatory signals and associates with
clinical benefit in CD patients. Since TGF-b1 is pro-fibrogenic, it
remains unclear whether Mongersen-induced Smad7 inhibition
increases risk of intestinal fibrosis.
Aim: To assess the impact of Smad7 inhibition by Mongersen on the
course of colitis-driven intestinal fibrosis in mice.
Material and methods: Chronic colitis-driven fibrosis was induced
in BALB/c female mice by rectal administration of increasing doses
of trinitrobenzene sulfonic acid (TNBS). Mice were given TNBS
once a week for 7 weeks. At week 4, a time-point in which mucosal
inflammation stimulates collagen deposition, Mongersen or control
oligonucleotide were administered to mice by oral gavage every
48 hours until week 7. At the end, colonic samples were taken for
histologic examination, total RNA and protein extraction.
Results: TNBS-induced chronic colitis was associated with
enhanced expression Smad7, diminished TGF-b 1-associated
Smad2/3 phosphorylation (p) and elevated levels of TGF-b 1 RNA
transcripts. As expected mice treated with TNBS exhibited colonic
deposition of collagen I and fibrosis. Knockdown of Smad7 with
Mongersen reduced colitis, deposition of collagen and attenuated
fibrosis development. Interestingly, these findings were associated
with diminished expression of both TGF-b1 RNA and p-Smad2/3.