Page 51 - Magyar Gasztroenterológiai Társaság 2020. november 6–7. – ONLINE KONGRESSZUS

Előadáskivonatok / Abstracts

pancreatitis szerepel. Emiatt pancreatico-cysto- complete fistula closure was achieved in 6 cases, partial
jejunostomia, majd Roux szerinti GEA és choledocho- remission occurred in 5 cases and in 17 cases there was no
jejunostomia történt. Keringésmegingással járó melaena worsening of symptoms.
miatt 2015 és 2016 között számos alkalommal hospitalizáltuk Conclusion: Surgical interventions are indicated in selective
osztályunkon. A vérzésforrást sem komplett endoszkópos, perianal Crohn's disease patients. The indications are well
sem képalkotó vizsgálatokkal nem tudtuk lokalizálni. Végül described in international guidelines, but in some aspects the
sürgős hasi angiographia során, a vénás fázisban, post lack of evidence make the guidelines shallow. The timing, the
operatív vena portae (VP) és vena mesenterica superior removal of the setons and the follow up were analysed in our
(VMS) stenosis következtében kialakult duodenalis és samples. Interventions often complicated by recurrences and
gastricus kollateralis vénák igazolódtak a vérzés hátterében. loss of response. The surgeon plays a pivotal role in caring
VP és VMS stenosis tágítását és stentelését, valamint for these patients, but the collaboration of the surgery and
varixok szelektív embolizációját követően a vérzés gastroenterology department is even more necessary to
megszűnt. achieve better quality of life and prevent social, sexual and
2. B. J. 67 éves férfibeteg anamnéziséből toxikus eredetű environment disabilities.
cirrhosis hepatis emelendő ki. Hemodinamikai instabilitással 45. PATIENT REPORTED OUTCOMES, PARTIAL MAYO
járó haematochesia miatt 2019-ben kezeltük osztályunkon. SCORE AND SCCAI ARE EQUALLY ACCURATE IN
Urgens gastroscopia során, a lezajlott friss vérzésre utaló PREDICTING MUCOSAL HEALING IN UC: PRELIMINARY
jelek ellenére, egyértelmű vérzésforrást nem tudtunk RESULTS FORM A PROSPECTIVE STUDY
3
2
3
1
azonosítani. Sürgős hasi CT angiographia duodenum varix Golovics P. , Gönczi L. , Reinglass J. , Verdon C. , Afif W. ,
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3
3
1
rupturát igazolt. Akut TIPS implantációt és a kitágult Wild G. , Bitton A. , Seidman E. , Herszényi L. , Bessissow
3
2,3
kollaterális vénák szelektív embolizációját végeztük, melyet T. , Lakatos P.
3
követően újravérzés nem fordult elő. 1. Division of Gastroenterology, Medical Centre, Hungarian
Conclusion: Amennyiben gastrointestinalis vérző betegnél Defence Forces, Budapest, Hungary; 2. 1st Department of
portalis hypertonia ismert és endoscopia során egyértelmű Medicine, Semmelweis University, Budapest, Hungary; 3.
vérzésforrást nem találtunk, gondolnunk kell ectopiás varix Division of Gastroenterology, McGill University Health
vérzés lehetőségére is. Az esetek jelentős részében Centre, Montreal, Canada
különböző radiológiai metodikák biztosítják a diagnózist és a
hatékony terápiát is. Introduction: Optimal management of patients with
ulcerative colitis (UC) requires the accurate assessment of
44. PERIANAL CROHN’S DISEASE SURGICAL AND disease activity. Endoscopic evaluation is considered the
MEDICAL TREATMENT IN CLOSE COLLABORATION gold standard approach, but it is invasive.
2
1
Golovics P. , Takács T. , Pálinkás D. , Hajdú H. , Schafer Aims: We aimed to determine how strong patient reported
1
1
E. , Iványi A. , Zsigmond F. , Gyökeres T. , Lestár B. , outcomes, clinical scores and symptoms correlate with
1
1
1
2
2
Szamosi T. , Herszényi L. endoscopy for assessment of disease activity in UC patients.
1
1
1. Gastroenterology Department, Medical Centre, Hungarian Methods: 136 patients were included prospectively and
Defence Forces; 2. Surgery Department, Medical Centre, consecutively (age: 48 (IQR: 38-61) years, duration 12 (4-
Hungarian Defence Forces 19)years, 63 females, 53.7% extensive disease, 40.4% on
biologicals) at the time of the colonoscopy. The 2 item patient
Introduction: Perianal Crohn’s disease affects a significant reported outcome (PRO), partial MAYO, Simple Clinical
number of patients with Crohn’s disease (CD) and is Colitis Activity Index (SCCAI), Mayo endoscopic subscore
associated with poor quality of life. The incidence of perianal (MES), Baron and Ulcerative Colitis Endoscopic Index of
Crohn’s disease (pCD) ranges from 17% to 43% of CD Severity (UCEIS) scores were calculated. C reactive Protein
cases. The surgical and medical management of the (CRP) and fecal calprotectin (FCAL) was available in 58.1
fistulizing perianal Crohn’s disease is challenging. and 33.8% of patients. 20.7% had clinical flare, treatment
Aims: Our aim was to analyse the prevalence, the predictors was escalated in 17.8% of patients. Sensitivity, specificity,
and the outcome of the perianal interventions in the biological PPV and NPV values were calculated, ROC analysis and K-
era in a tertial referral centre between 2018 August and 2019 statistics were performed.
August. Results: : Rectal bleeding (RBS), stool frequency (SF)
Methods: Data of 33 consecutive patients were collected subscore of 0, or total PRO2 remission (RBS 0 and SF ≤1),
and analysed between 2018.08.01 and 2019.08.01 from the partial MAYO (≤2) and SCCAI (≤2.5) remission were similarly
surgery department. Both in- and outpatient records were associated to mucosal healing defined by MES (0 or ≤1) or
collected and comprehensively reviewed. Baron (0 or ≤1) scores (Table 1). PRO2 remission
Results: 33 perianal Crohn’s disease patients (18 male, 15 (AUCMES0/Baron0:0.747/0.715, AUCMES0-1/Baron0-1:0.867/0.863),
female) were operated and performed totally 44 surgical SF (AUCMES0/Baron0:0.731/0.703, AUCMES0-1/Baron0-
interventions. Almost the complete population was managed 1:0851/0.839), RBS (AUCMES0/Baron0:0.708/0.685, AUCMES0-
by the gastroenterology department of the same institute. 1/Baron0-1:0.828/0.835) partial Mayo
Predominantly biological therapy was administered in the (AUCMES0/Baron0:0.792/0.755, AUCMES0-1/Baron0-1:0.917/0.903)
majority of the patients (N=29), in 6 cases biological therapy and SCCAI (AUCMES0/Baron0:0.738/0.724, AUCMES0-1/Baron0-
change, in further 6 cases dose escalation were necessary. 1:0.908/0.880) were similarly associated with mucosal
Only 7 simplex cases were in this period. Complex fistulas healing in a ROC analysis. There was a string association
(N=26) are treated with seton drainage, carefully selected between MES and Baron (k=0.798), while moderate
patients have been treated with darvadstrocel within the agreement between UCEIS and MES (K=0.451) or Baron
confines of a study (N=3). Abscesses were evacuated (K=0.499) scores. Agreement between CRP and clinical
(N=21), the underlying fistula was drained. In one case remission or endoscopic healing (MES/Baron) was poor
urgent stoma formation was needed because of the septic (K~0.2), while agreement between FCAL (>100 or >250) and
condition despite the seton drainage (N=1). Rectovaginal RBS-PRO2 remission (K>250:0.56-0.61) or MES/Baron 0 was
fistulae (N = 5) were managed predominantly with seton moderate to good (K>100:0.54-0.53 and K>250:0.50-0.54)
placement. After the surgical procedure complete or near-
49

Central European Journal of Gastroenterology and Hepatology 49
Volume 6, Supplementum 2 / November 2020