Abstracts of the 23rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223
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P.06.22 FULLY COVERED SELF-EXPANDABLE METAL STENT IN THE MANAGEMENT OF DIFFICULT CHOLEDOCHOLITHIASIS G. Grande ∗,1 , F. Pigò 1 , A. Caruso 1 , M. Manno 2 , C. Zulli 1 , H. Bertani 1 , S. Mangiafico 1 , R. Manta 1 , V.G. Mirante 2 , F. Di Mario 3 , R. Conigliaro 1 1 Gastroenterology and Digestive Endoscopy Unit, NOCSAE Hospital, AUSL of Modena, Italy; 2 Gastroenterology and Digestive Endoscopy Unit, Carpi Hospital, AUSL of Modena, Italy; 3 Department of clinical and Experimental Medicine, University of Parma, Italy
Background and aim: Difficult to treat choledocholithiasis represents up to 15% of cases of retained biliary stones and to date, it is a challenging condition with no standard treatment. Literature supporting the temporary use of fully covered self expandable metal stent (FCSEMS) are scanty. Our aim was to assess the efficacy and the safety of FCSEMS in the management of difficult common bile duct stones. Material and methods: From February 2012 to September 2016 we have retrospectively analysed 54 cases of difficult extrahepaticduct biliary stones, treated with at least one FCSEMS, after an unsuccessful attempt of endoscopic stone extraction, in two Italian tertiary referral centres. Follow-up ERCP was performed for stent removal and subsequent attempt of duct clearance. In case of retained stones, other additional treatments such as Extracorporeal Shock-Waves Lithotripsy (ESWL), Dilation Assisted Stone Extraction (DASE) and surgery were given until complete bile duct clearance were obtained. Data regarding patient’s characteristics, bile duct and stone features, type of FCSEMS, procedure- related adverse events, were also recorded. Results: FCSEMS placement was successful in all 54 patients. One patient died for massive delayed bleeding occurred after endoscopic sphincterotomy, despite FCSEMS placement and selective arterial embolization. Complete duct clearance with only FCSEMS placement was achieved in 32 of 53 patients (60%) after a mean time of 34 days (Group A). In order to obtain complete bile duct clearance, 21 patients (Group B) underwent to additional treatment as DASE (6 patients), ESWL (8 patients), ESWL + DASE (6 patients); surgery (1 patient). At univariate analysis, the diameter of the stone was the only predictive
Figure 1
factor of unsuccessful treatment with only FCSEMS (stone diameter 16.8±5.1 mm vs. 20.3±4.1 mm; p-value 0.01 and stone diameter ≥20 mm 34% vs. 67%, p-value 0.02, OR 3.8 (1.2–12–2) in group A and B, respectively). Stent migration occurred in 11 cases with no clinical consequences. Mild adverse events occurred in 12 of 53 patients (5 post-sphincterotomy bleeding, 4 pancreatitis, 3 cholangitis) over 156 ERCP performed, without significant differences among the two groups. Conclusions: FCSEMS represents a safe, effective and wide available first-line treatment in the management of difficult choledocholitiasis. According to our case series, the use of FCSEMS could be useful as a single treatment for not giant bile stones. Although this is the largest case series available at the moment, further studies are needed to asses the most suitable type of stent and its indwell time to reach the best results.
P.06.23 CAPSULE ENDOSCOPY – ACCURACY AND PROGNOSTIC VALUE OF SMALL BOWEL LESIONS IN PATIENTS WITH CROHN’S DISEASE C. Calabrese ∗ , M. Diegoli, P. Gionchetti, A. Cappelli, C. Ricci, N. Pagano, A. Calafiore, M. Campieri, F. Rizzello Policlinico S. Orsola Malpighi, Bologna, Italy Background and aim: The classification of Crohn’s disease (CD) is usually determined at initial diagnosis and is frequently based on ileocolonoscopic and cross-sectional imaging data. Advanced endoscopic and imaging techniques may provide additional data regarding disease extent and phenotype. Our aim was to examine whether capsule endoscopy (CE) or cross sectional imaging thecniques performed after the initial diagnosis may alter the original disease classification. Material and methods: Patients referred for CE between January 2010 and December 2015, with a known CD diagnosis, who also underwent cross-sectional imaging (CTE or/and MRE) were identified from the database and included in the study. A retrospective chart review was undertaken of all eligible study candidates. Only patients with a minimum follow up of 12 months available after the procedure were included and data were collected to assess the CE findings and to correlate with subsequent clinical diagnosis and outcome. Clinical data collected included: patient demographics, the duration of CD, previous bowel surgeries, results of previous abdominal computerized tomographic scans, results of ileocolonoscopy and histology; data were retrieved from patients medical records; a Harvey-Bradshaw Index (HBI) was recorded at the time of CE. Exclusion criteria included any documentation of nonsteroidal anti-inflammatory drug (NSAID) use in the 3 months prior to SB examination; any patient with less than 6 months of follow up
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