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

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e142 Abstracts of the 22nd National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
Median age was 32.44 and 72 were women. 80 patients (2.4%) had
a solid lesion. The final diagnosis was pancreatic neuroendocrine
tumor (pNET) in 38 patients, adenocarcinoma in 23 patients,
pseudopapillary solid tumor in 11 patients, autoimmune pancreatitis
in3patients, focal pancreatitis in3patients, intrapancreatic accessory
spleen in 1 patient. Cytology was not diagnostic in 1 patient, the
diagnosis was granulocytic sarcoma at surgical histology. All cases
of adenocarcinoma were observed between 31 and 40 years, pNETs
were observed between 19 and 39 years. Among pNETs, Ki67 index
was evaluated on cytological samples in 63% of cases.
Review of medical records for the 6 patients with negative FNA
diagnoses who did not have surgical follow-up was performed for at
least 6 months following the FNA, and none of these patients were
demonstrated to having neoplasms during follow-up period. The
sensitivity and specificity of EUS-guided FNA to identify malignancy
were 98% and 100% respectively.
Conclusions: In our series, solid pancreatic tumors occurring in
young adults younger than 40 yearswere rare (<3% of our population).
Of the 73 malignant diagnoses, pNET was the most common and
accounted for 52% of cases. Our experience demonstrates that EUS-
FNA has fundamental clinical value for diagnostic evaluation of
younger patients who present solid masses of the pancreas.
P.03.8
ACCESSING TO THE LEFT PARATRACHEAL (#4L) AND THE
AORTOPULMONARY WINDOW (#5) MEDIASTINAL LYMPH NODES
BY ENDOSCOPIC ULTRASOUND WITH FINE NEEDLE ASPIRATION
(EUS-FNA)
Assisi D.*, Forcella D., Melis E., Filippetti M., Pierconti F., Lapenta R.,
Facciolo F., Anti M.
Regina Elena National Cancer Institute, Roma, Italy
Background and aim: Accurate lymph node staging is mandatory
in case of enlarged mediastinal lymph nodes (MLN) in patients
with suspected lung cancer or extrathoracic neoplasia. Efficacy of
less invasive technique for lymph node biopsies is well established.
Many authors believe that surgery is the preferred approach to
biopsy the 4 and 5 lymph nodes because poor efficacy of EUS-FNA
in these mediastinal nodal stations. We evaluated accessing the left
paratracheal (#4L) and aortopulmonary window (#5) stations by
EUS FNA.
Material and methods: In our series of 211 EUS FNA, performed
in 200 consecutive patients (127 men) with median age of 65
years from January 2011 to January 2015, we examined by EUS the
lower mediastinal nodes (stations #8 and #9), the nodes of the
aorto-pulmonary window (station #5), the left paratracheal nodes
(stations #2L and #4L), the retrotracheal nodes (station #3P), the
subcarinal nodes (station #7) and paraesophageal lung masses.
In 154 of these patients (77%) we performed EUS-FNA only on
enlarged MLN.
EUS-FNA was performed on the following mediastinal sites
according to the regional lymph-node map definitions: on station
#7 (subcarinal area dorsally to the origin of the left pulmonary
artery and cranial to the left atrium) in 123 cases; on station #4L
(to the left of the left lateral border of the trachea, medial to the
ligamentum arteriosum; between upper margin of the aortic arch
and upper rim of the left main pulmonary artery) in 15 cases ; on
station #5 (laterally to station #4L with ligamentum arteriosum as
anatomic border) in 16 cases.
Results: The overall sensitivity of EUS FNA in this series was 81.1%
with a corresponding negative predictive value (NPV) of 52.1% and
accuracy of 85%. In lymph node station #7 the sensitivity of EUS-FNA
to detect malignancy was 82.1%, VPN was 55% and accuracy 87.5%;
in station #4L sensitivity was 70%, VPN was 57% and accuracy 78.5%;
in station #5 sensitivity was 80%, VPN was 25% and accuracy 81.2%.
In our series sensitivity of EUS FNA for station #4L and #5 was
higher than reported in other study.
Conclusions: These results suggest that routine use of EUS-FNA as
an initial investigation after a staging CT scan or/and PET for enlarged
MLN results in a better approach than surgery in mediastinal
stations. Furthermore we think that also #4L and #5 stations are
reachable by trained operator by transesophageal EUS FNA with a
good performance, safe and accuracy.
P.03.9
IS ENDOSCOPIC ULTRASONOGRAPHY USEFUL IN SUBJECTS
HAVING ASYMPTOMATIC CHRONIC PANCREATIC
HYPERENZYMEMIA?
Antonini F.*1, Valerio B.1, Pagano N.2, De Minicis S.1, Lo Cascio M.1,
Marraccini B.1, Piergallini S.1, Rossetti P.1, Andrenacci E.1, Macarri G.1,
Pezzilli R.2
1 Ospedale A.Murri, Fermo, Italy, 2Ospedale Sant’orsola, Bologna, Italy
Background and aim: We have previously shown that at least 50% of
patients having asymptomatic chronic pancreatic hyperenzymemia
(ACPH) may develop morphological pancreatic alterations. In
addition, it has been shown that endoscopic ultrasonography (EUS)
may detect small lesions and its sensitivity appears to be higher
than other imaging techniques. The aim of this study was to evaluate
if EUS may modify the management of patients having ACPH.
Material and methods: In two referral centers for pancreatic
disease, a retrospective analysis of prospectively enrolled patients
with ACPH was conducted.
Results: 73 patients with ACPH were enrolled for the purpose of
this study (35 males, 38 females, mean age 58.9 years, range 22-
91 years).The mean±SD duration of pancreatic hyperenzymemia
was 8.7 years±4.6 years. Mean amylase concentration was 304
IU/L (range 101-2082, upper reference limit 110) and mean lipase
concentration was 248 IU/L (range 25-2941, upper reference limit
60). Seven subjects had a familial ACPH and their amylase ad lipase
concentration were not statistically different as compared to those
of 66 patients having sporadic ACPH (P=0.790). 61 patients (83.5%)
underwent abdominal ultrasonography, magnetic resonance
imaging (MRI) associated with MRI cholangiopancreatography was
carried out in 41 (56.1%), contrast-enhanced computed tomography
in 32 (43.8%), and ERCP was performed in one patient (1.3%). All
these imaging studies did not revealed pancreaticobiliary disease.
In 45 patients (61.6%) an EUS was also performed. Using this
technique in 7 subjects abnormalities were found: 3 branch-duct
IPMNs (having a size more than 10 mm), 1 duodenal diverticulum, 1
annular pancreas, 1 findings suggestive of chronic pancreatitis, and
1 undefined cyst (<5 mm).
Conclusions: EUS is able to detect alteration not found by other
imaging technique in 15.5% (7/45) of patients with ACPH and may be
useful to select those patients who requires a more strict follow-up.
P.04 Upper GI Disorders
P.04.1
CORRELATION BETWEEN SEASONAL EXACERBATIONS OF UPPER
GI SYMPTOMS AND NUMBER OF 13C-UREA BREATH TESTS
PERFORMED IN A LARGE UNIVERSITY HOSPITAL
Petruzziello C., Tesori V., Graziani C., Franceschi F., Gasbarrini A.,
Ojetti V.*
Università Cattolica del Sacro Cuore, Roma, Italy