Small bowel Crohn’s disease: MR enteroclysis and capsule endoscopy compared to balloon-assisted enteroscopy

New modalities are available to visualize the small bowel in patients with Crohn’s disease (CD). The aim of this study was to compare the diagnostic yield of magnetic resonance enteroclysis (MRE) and capsule endoscopy (CE) to balloon-assisted enteroscopy (BAE) in patients with suspected or established CD of the small bowel. Consecutive, consenting patients first underwent MRE followed by CE and BAE. Patients with high-grade stenosis at MRE did not undergo CE. Reference standard for small bowel CD activity was a combination of BAE and an expert panel consensus diagnosis. Analysis included 38 patients, 27 (71%) females, mean age 36 (20–74) years, with suspected (n = 20) or established (n = 18) small bowel CD: 16 (42%) were diagnosed with active CD, and 13 (34%) by MRE with suspected high-grade stenosis, who consequently did not undergo CE. The reference standard defined high-grade stenosis in 10 (26%) patients. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value of MRE and CE for small bowel CD activity were 73 and 57%, 90 and 89%, 88 and 67%, and 78 and 84%, respectively. CE was complicated by capsule retention in one patient. MRE has a higher sensitivity and PPV than CE in small bowel CD. The use of CE is considerably limited by the high prevalence of stenotic lesions in these patients

547 CHOLANGIOCARCINOMA IN ITALY: A NATIONAL SURVEY ON DEMOGRAPHIC AND CLINICAL CHARACTERISTICS, DIAGNOSTIC MODALITIES AND TREATMENT

We report the results of a survey promoted in Italy by the AISF“Cholangiocarcinoma” (CCA) committee aimed to evaluate the demographic and clinical characteristics of IH(intra-hepatic)- and EH(extra-hepatic)-CCA. Members of AISF (Italian Association Liver Disease) and SIGE (Italian Society of Gastroenterology) were asked to fill out a questionnaire describing CCA patients recruited in the last 12 months. 218 consecutive incident CCA cases were analyzed. 47% were EH-CCA and 53% IH-CCA with an age higher for EH-CCA. A history of past smoking, cirrhosis, viral cirrhosis and positivity for viral hepatitis markers were more frequent in IH-CCA than EH-CCA. The clinical onset of the disease was earlier for IH-CCA than EH-CCA. An incidental asymptomatic presentation occurred in 28% of IH-CCA vs 4% EH-CCA while 74% EH-CCA presented with jaundice vs 28% IH-CCA. Abdominal pain without other symptoms was more frequent in IH-CCA (19.8 vs 4%). Of the 116 IH-CCA cases, 91% presented as single intra-hepatic mass, while 50% EH-CCA was peri-hilar. Diagnosis was time- and cost-consuming since 70% of all CCA cases received at least 3 different imaging procedures. Tissue- proven diagnosis was obtained in 80% of cases. As far as treatment was concerned, 57% of IH-CCA and 42% of EH-CCA received opensurgery. However, surgery was considered curative in 50/116 IH- CCA (43%) vs 17/102 (17%) EH-CCA. 18% of IH- vs 4% of EH-CCA received no treatment. In conclusion, in Italy IH-CCA is managed as frequently as EH-CCA. In comparison with EH-CCA, IH-CCA occurs at younger age, is more frequently associated with smoking habits, cirrhosis and/or hepatitis virus infection and with an incidental asymptomatic presentation. In contrast, most EH-CCA are jaundiced at the diagnosis. CCA diagnostic management is cost- and time- consuming with a curative surgical treatment applicable in 43% IH-vs 17% EH-CCA

Vascular Anomalies Guidelines by the Italian Society for the study of Vascular Anomalies (SISAV)

n

Vascular anomalies Guidelines by the Italian Society for the study of Vascular Anomalies (SISAV)

n