UEG Week 2014 Poster Presentations

United European Gastroenterology Journal

2(1S) A132A605
! Author(s) 2014
Reprints and permissions:
sagepub.co.uk/journalsPermissions.nav
DOI: 10.1177/2050640614548980
ueg.sagepub.com

MONDAY, OCTOBER 20, 2014

9:0017:00
POSTER PLUS VIDEO I POSTER EXHIBITION HALL XL_____________________
P0001 EUS GUIDED TRANSMURAL DRAINAGE OF WOPN;
COMPARISON BETWEEN A NEW FULLY COVERED LARGE BORE
WIDE FLARE METAL STENT (NAGI STENT) VS MULTIPLE
PLASTIC STENTS: A SINGLE CENTRE RETROSPECTIVE STUDY
N. Dubale1,*, A. Bapaye2, S.K. Davavala1, H. Gadhikar1, S. Dhadpahale1,
S. Date1, J. Bapaye3
1
Digestive Diseases and Endoscopy, 2Digestive Diseases and Endoscopy, Deenanath
Mangeshkar Hospital and Research Centre, Pune, 3Shreemati Kashibai Nawale
Medical College, Pune, India
Contact E-mail Address: amolbapaye@gmail.com
INTRODUCTION: WOPN is a frequent sequel of acute necrotizing pancreatitis.
The best approach for drainage of these collections is still controversial. We
present our retrospective data comparing the two endoscopic methods for drainage of WOPN.
AIMS & METHODS: Outcomes of patients undergoing EUS guided transmural
drainage (EUTMD) using a newly designed fully covered large-bore wide-flare
metal stent (Nagi stent) (Gr I) were compared to the outcomes of patients who
underwent placement of multiple plastic stents (Gr II). The pre-op CECT confirmed suitability of endoscopic drainage based on location, wall thickness &
contents. Visual quantification of necrosis (450% solid debris) by EUS excluded
8 patients (3 in Gr I and 5 in Gr. II). The procedure in both groups is done by
standard technique by a single endoscopist. The difference between the two
groups was tract dilatation (6 mm in Gr I vs. 18 mm in Gr II). Placement of
NCT and subsequent necrosectomy was done whenever necessary. Follow-up
imaging was done at 72 hrs and thereafter at 2, 4, & 6 weeks. The outcomes
were compared in terms of clinical success, need for surgery, complications,
hospital stay and mortality.
RESULTS: N: 21(Gr. I), 61(Gr. II). The two groups were comparable in terms of
demographics, etiology of pancreatitis, cyst location, size and amount of debris.
Placement of NCT, need of necrosectomy and no of sessions required were also
not different between the two groups. Clinical success defined as resolution of
symptoms was seen in 100% of Gr. I patients vs. 73% in Gr. II (p 0.048). None
of the patients in Gr I required subsequent surgery vs 20/61 (32.7%) in Gr. II
(p 0.025). Complications: 15% in Gr. I vs 37% in Gr. II (p 0.016)
Mean hospital stay was 4 days (1-33) in Gr. I vs 8 (4-65) in Gr II (p 0.012).
Mortality was none in Gr. I vs. 6.5% (4/61) in Gr. II (p 0.22)
CONCLUSION: The Nagi stentTM is effective and safe for EUTMD of WOPN.
It permits rapid clinical resolution with 100% technical and clinical success rates.
It offers distinct advantage over plastic stents although further prospective studies are warranted.
Disclosure of Interest: None declared
P0002 ENDOSCOPIC ESOPHAGEAL RECONSTRUCTION FOR THE
TREATMENT OF A TOTAL AND EXTENSIVE DISRUPTION OF
THE ESOPHAGUS USING A RENDEZ-VOUS TECHNIQUE
J.-M. Gonzalez1,*, G. Vanbiervliet2, M. Barthet1
1
Gastroenterology, Aix-Marseille University, North Hospital, Marseille,
2
Gastroenterology, Nice Hospital, Nice, France
INTRODUCTION: Complete esophageal obstruction leads to definitive fasting.
The rendez-vous endoscopic approach had already been described for complex
stenoses as an alternative to surgery that has high morbid-mortality.
AIMS & METHODS: This is a case series report about six patients referred for
complete esophageal disruption classified in two groups: 1/ Long disruption (4
5cm), one after caustic ingestion and two due to an esophageal stripping during
SEMS removal. Two had an associated loss of the SES; 2/ Short disruption (5
5cm), consecutive to radiation therapy for a neck neoplasia. They had been
fasting for 3 to 18 months. All the procedures were performed according the
anterograde retrograde approach, under anesthesia and with CO2 insufflation
and X-rays guidance.
RESULTS: There were 3 men and women between 25 and 71 years old. All the
reconstructions have been successful in one to three endoscopic sessions, using
the non hydrophilic tip of a guide wire passed through a straight catheter in 5
cases and a EUS needle in only one case. In 2 cases, a neo-SES had to be created,
by transillumination (n 1) or head and neck surgery (n 1). In order to guide
the reconstruction, SEMS was used in one case, NGT in one case, and both were
used in one patient. The first dilation was performed with a CRE balloon
(12-15mm). All the patients could eat mixed after 2 POD. There was no intraoperative or post-operative complication. Then, the patients underwent 3 to 18
dilations sessions during 1.5 to 15 months; two are still undergoing dilations and
all eat normally.
CONCLUSION: Endoscopic rendez-vous for esophageal reconstruction is safe
and effective in case of esophageal disruption even with loss of SES, avoiding
surgery.
Disclosure of Interest: None declared

P0003 ENDOSCOPIC SUBMUCOSAL DISSECTION

GASTRIC CANCERS USING THE CLUTCH CUTTER

OF

EARLY

K. Akahoshi1,*, Y. Motomura1, M. Kubokawa1, J. Gibo1, N. Kinoshita1,

S. Osada1, Y. Shimokawa1, K. Tokumaru1, Y. Otsuka1, T. Hosokawa1,
N. Tomoeda1, R. Utsunomiya1, T. Miyazaki1, K. Miyamoto1, M. Oya1
1
Gastroenterology, ASO IIZUKA HOSPITAL, Iizuka, Japan
Contact E-mail Address: kakahoshi2@aol.com
INTRODUCTION: To reduce the risk of complications related to ESD using
conventional knives, we developed the Clutch Cutter (CC), which can grasp and
incise the targeted tissue using electrosurgical current.
AIMS & METHODS: From June 2007 to March 2014, 325 consecutive patients
(228 men, 97 women; mean age 74 years, range 35-95) with a diagnosis of intramucosal or superficial submucosal gastric cancer without lymph node involvement, that had been confirmed by preliminary endoscopy, EUS, and endoscopic
biopsies, were enrolled into this prospective study. The CC was used for all steps
of ESD (marking, circumferential marginal incision, submucosal dissection, and
hemostatic treatment). The therapeutic efficacy and safety were assessed.
RESULTS: The mean size of the early gastric cancers and resected specimens was
17.3 mm and 46.7 mm, respectively. The mean operating time was 97.2 minutes.
The rate of en-bloc resection was 99.7% (324/325), and en-bloc resection with
tumor-free lateral/basal margins (R0 resection) was 95.1% (309/325), respectively. The R0 resection rates according to tumor size and location were 97.4%
(229/235) in less than 20 mm, 88.9% (80/90) in larger than 20 mm; 96.9%
(127/131) in lower portion, 91.9% (91/99) in middle portion, and 94.7% (91/
95) in upper portion. The mean operating time according to tumor size and
location was 93.4 min in less than 20 mm, 140 min in larger than 20 mm; 73.9
min in lower portion, 108.8 min in middle portion, and 117.2 min in upper
portion. Perforation during ESD occurred in one case (0.3%), which was managed with conservative medical treatment after endoscopic closure of the perforation. Post ESD bleeding occurred in 11 cases (3.4%), which were successfully
treated by endoscopic hemostatic treatment.
CONCLUSION: ESD using CC is a safe and technically efficient method for
resecting early gastric cancers.
REFERENCES
1) Akahoshi K, Akahane H, Murata A, et al. Endoscopic submucosal dissection
using a novel grasping type scissors forceps. Endoscopy 2007; 39: 1103-1105.
2) Akahoshi, K, Akahane H, Motomura Y, et al. A new approach: endoscopic
submucosal dissection using the clutch cutter for early stage digestive tract
tumors. Digestion 2012: 85: 80-84.
Disclosure of Interest: K. Akahoshi Other: Kazuya Akahoshi and FUJIFILM
have applied for the patent in Japan, Europe, and USA for the Clutch Cutter
described in this article. China has already granted the patent., Y. Motomura:
None declared, M. Kubokawa: None declared, J. Gibo: None declared, N.
Kinoshita: None declared, S. Osada: None declared, Y. Shimokawa: None
declared, K. Tokumaru: None declared, Y. Otsuka: None declared, T.
Hosokawa: None declared, N. Tomoeda: None declared, R. Utsunomiya:
None declared, T. Miyazaki: None declared, K. Miyamoto: None declared, M.
Oya: None declared
P0004 ENDOSCOPIC MYOTOMY FOR ACHALASIA USING A
COMBINATION OF NESTIS WATER JET SYSTEM AND HOOK
KNIFE: EVALUATION OF THE SAFETY AND THE EFFECTIVENESS
M. Pioche1,2,*, S. Roman3, M. Ciocirlan4, F. Mion3, T. Ponchon5
Gastroenterology and endoscopy, Hopital Edouard Herriot, 2Inserm U1032,
3
Functional disorders unit, Hopital Edouard Herriot, Lyon, France,
4
Gastroenterology and endoscopy unit, Institut Carol Davila, Bucharest, Romania,
5
Gastroenterology and endoscopy unit, Hopital Edouard Herriot, Lyon, France
Contact E-mail Address: mathieupioche@free.fr
1

INTRODUCTION: The peroral endoscopic myotomy (POEM) is a promising

method for the treatment of the esophageal achalasia. But the precise technique
can be refined. We developed a combined technique of water jet system for
tunnelling and hook knife section for myotomy and we evaluated its results in
a prospective study.
AIMS & METHODS: The patients presented with an achalasia without any
prior instrumental treatment. The submucosal tunnel was created 12 cm over
the cardia and 3 cm below, and then the endoscopic myotomy was performed
using the Olympus Hook Knife by a single operator with CO2 insufflation,
beginning 8 cms over the cardia and finishing 2 cms below. The clinical evaluation was realized before and then after the procedure at 1, 3, 6 and 12 months
(score of Eckardt, score of quality of life GIQLI). A high-resolution manometry
was realized before POEM and 3 months later to classify the achalasia (classification of Chicago) and to measure basal pressure and pressure of relaxation
integrated (PRI) of the lower esophageal sphincter. Then an esophageal
pHmetry of 24 hours was performed at 3 months to diagnose GERD. The