C. De Angelis

The importance of endoscopic ultrasonography in the management of low-grade gastric mucosa-associated lymphoid tissue lymphoma

Background : Anti‐Helicobacter pylori therapy has been reported to cause regression of low‐grade gastric mucosa‐associated lymphoid tissue lymphoma in a high percentage of patients. However, in some patients, these lesions persist despite antibiotic treatment.

Adrenaline plus cyanoacrylate injection for treatment of bleeding peptic ulcers after failure of conventional endoscopic haemostasis

BACKGROUND Endoscopic therapy is a safe and effective method for treating non-variceal upper gastrointestinal bleeding. However failure of therapy, in terms of continuing bleeding or rebleeding, is seen in up to 20%. Cyanoacrylate is a tissue glue used for variceal bleeding that has occasionally been reported as an alternative haemostatic technique in non-variceal haemorrhage. AIM To retrospectively describe personal experience using cyanoacrylate injection in the management of bleeding ulcers after failure of first-line endoscopic modalities. PATIENTS AND METHODS Between January 1995 and March 1998, 18 [12 M/6 F, mean age 68.1 years) out of 176 patients, referred to our Unit for non-variceal upper gastrointestinal bleeding, were treated with intralesional injection of adrenaline plus undiluted cyanoacrylate. Persistent bleeding after endoscopic haemostasis or early rebleeding were the indications for cyanoacrylate treatment. RESULTS Definitive haemostasis was achieved in 17 out of 18 patients treated with cyanoacrylate. One patient needed surgery. No early or late rebleeding occurred during the follow-up. No complications or instrument lesions related to cyanoacrylate were recorded. CONCLUSIONS In our retrospective series, cyanoacrylate plus adrenaline injection was found to be a potentially safe and effective alternative to endoscopic haemostasis when conventional treatment modalities fail in controlling bleeding from gastroduodenal ulcers.

223 SEDATION FOR ENDOSCOPY IN PATIENTS WITH END- STAGE LIVER DISEASE: RESULTS OF A PROSPECTIVE CONTROLLED STUDY

Background: There are no formal guidelines regarding sedation for endoscopy in cirrhotic patients (CP). The use of propofol has been shown to be effective and safe for gastroscopy but its use for prolonged endoscopic procedure remains to be studied. Aim: To evaluate the efficacy and safety of propofol in CP undergoing prolonged endoscopic procedures compared with non-cirrhotic patients (NCP). Methods: Twenty-nine consecutively collected inpatients (mean age 58±SD7, M/F=18/11) with known liver cirrhosis (Child–Pugh class A=12, B=9, C=8) undergoing colonoscopy (21) or ERCP (8) received propofol by an anesthetist; the outcome measures studied (induction and recovery times, efficacy and safety of sedation, return to baseline function) were compared with those recorded among 68 consecutively collected NCP (mean age 61±SD8, M/F=41/27) undergoing the same endoscopic procedures (colonoscopy: 49, ERCP: 19). Results: The mean dose of propofol administered in CP was 242mg (SD±38, range 100–350) compared with 260mg (SD±8, range 120–380) in NCP (p = 0.2). The mean time to achieve sedation was 2.8min (SD±1.1) in CP and 3.1 (SD±1.2) in NCP (p = 0.9). The mean time to reach a maximal level of alertness on the Observer’S Assessment of Alertness and Sedation Scale (OAASS) in CP was 13.8min (SD±4.2) compared with 12.7 (SD±4) in NCP (p = 0.7). Time to full recovery was 28.6min (SD±9.1) in CP compared with 26.2min (SD±8) in NCP (p = 0.72). Procedures times between the groups were similar: 26min (SD±12) in CP vs 29min (SD±14) in NCP (p = 0.8). No significant complication related to sedation was observed in the 2 groups. Conclusions: Propofol sedation is efficacious, safe and well tolerated in CP undergoing prolonged endoscopic procedures.