Aims ESD (endoscopic submucosal dissection) and EFTR (endoscopic full-thickness resection) are treatments of choice in the endoscopic resection of small and submucosal invasive GI lesions. It is often challenging to assess the best curative option in this setting.

Background The role diminutive polyps and small polyps play in the development of advanced neoplasia (AN) or cancer during follow-up (FU) continues to be debated. Recent studies have shown that the risk of AN development during FU is higher in patients with > 5 small polyps but similar in patients with – or – small polyps2,3. Given these findings, the current study aimed to evaluate if current European FU guidelines1 at first screening colonoscopy according to the number of low-grade dysplasia tubular adenoma < 1 cm (“micropolyps”, MP) are too strict. Methods A longitudinal cohort study was carried out on a representative sample (50%) of patients who underwent a screening colonoscopy (clean colon) in 2010 showing at least 1 polyp. Patients with AN or cancers were excluded. Polyps > 1 cm or villous or high grade dysplasia/carcinoma in situ were considered AN. These patients made a FU colonscopy according to UE screening CCR guidelines. Patients were split up according to European guidelines in Low risk (– MP), Intermediate risk (– MP) and High risk (>5 MP). Data were analyzed by SPSS program. Results Of 640 patients included in the sample 172 (27%) were included in the surveillance program (mean age 62,2± 5,7 yr, 5–0), 120 male (69,8%). During first colonoscopy (2010) 370 MP were detected (M±SD 2,1±1,5, range –3 polyps for each patient). During FU (median 5.5 years), 315 colonoscopies were performed (mean 1.8; range –) and an AN was detected in 23 patients (13.4%): 20/23 tubulovillous microadenoma, 1/23 high grade dysplasia, 2/23 tubular adenoma > 1 cm. The detection of AN among patients in treatment with ASA was non significantly lower than the others. AN detection was lower among Low risk patients (13/108; 10.7%) as compared to Intermediate risk (7/33; 17.5%) and High risk (3/8; 27.3%) (P=ns). According to Kaplan-Meier analysis, the cumulative risk of AN among High risk was significantly increased (p=0.035) (figure 1). No interval cancers were found during the follow-up. Conclusions These findings suggest that EU guidelines for surveillance colonoscopies for > 3 small LGD polyps are excessively strict. We propose extending the time for a repeat colonscopy FU for these patients to 5 yrs References Segnan N. et al. European Guidelines for Quality Assurance in Colorectal Cancer Screening and Diagnosis First Edition 2011 Chang MM, et al. Digest Liv Dis 2018; 50: 847–852 Jung YK, et al. Am J Gastroenterol 2018: 113(12):185–1.

Introduction Colorectal cancer (CRC) is a leading cause of cancer mortality in the Veneto Region (North-east Italy). Population screening of adults between 50 and 75 for CRC was begun in 2002, and it became standard practice in all 21 local health units (LHU) of the region in 2008, 14 LHU provided in the program also follow-up colonoscopy and 7 LHU no. This study was carried out to evaluate the impact on surgery rates of CRC screening and follow-up programs. Method This is a retrospective cohort study on administrative data based on anonymous computerised database of Veneto Region hospital discharges between 2000 and 2015. All Veneto residents (in screening age) discharge records with principal diagnosis of CRC treated with surgery were included in the study. The number of patients studied rose approximately 18% reaching 1,547,097 for the last year (2015). The Standardised Hospitalisation Ratio (SHR) per five-year age group was calculated and expressed per 10 000 population. Results During the study period, 30 399 surgical procedures for colorectal cancer were performed (colon 63%, rectum 36%, secondary malignant neoplasm 1%) with a SHR of 139.1, higher in males (OR: 1.66; CI 95%: 1.62–1.7; p<0.05). An analysis of the annual SHR distribution uncovered two distinct phases: during the first phase there was a rising tendency that reached a maximum value in 2007 (166,9; X2 trend: 46.731; p<0.05) and during the second there was a falling tendency that reached its minimum value in 2015 (102.3; X2 trend: 429.791; p<0.05), with a total reduction of 28%. The cancer stratification by site shows that the rate of surgical procedures of the proximal colon during the last year was the same as the 2000 value (41.5), instead there was a significant decrease (−37,3%; X2 trend: 559.282; p<0.05) in the rate of procedures on the distal colon and rectum which fell from 94.4 to 59.2 (Figure1). The stratification of LHU in which the screening program included a follow-up colonoscopy and others didn’t show significant difference in the reduction in surgical procedures (Figure2). Conclusion Study findings confirmed that CRC screening was effective in reducing the number of oncological surgical oncology procedures particularly with regard to the distal colon and rectum. Data analysis showed that the screening seemed to accelerate reaching the peak rate in surgical procedures that took place in 2007. After that time point the number of operations began to fall as far as the distal colon was concerned (it fell by 37.3%). Finally data suggest that the real benefit in reduction of oncological surgery procedures is due to the first screening colonoscopy. Disclosure of Interest None Declared

Background: The improvement of liver fibrosis assessed using transient elastography (TE) by FibroScan® is leading to new insights in the concepts of fibrosis regression. The possibility of using new direct antiviral agents (DAA) in cirrhotic patients, previous excluded from PegInterferon treatment for risk of hepatic failure, has permitted to verify the hypothesis of fibrosis regression in these patients. TE should be interpreted taking into account the inflammatory profile associated with hepatitis.

Background: Patients’ narratives have been suggested as a promising way to promote health, including colorectal cancer (CRC) screening, but evidence about their effectiveness is mixed. Aims: a) to provide a comprehensive review of the literature, and b) to investigate the effect of narratives conveying different emotions in promoting CRC screening.Methods: a) Systematic review of studies investigating narratives in CRC screening; b) Between-participant design comparing: usual leaflet (no-narrative condition), usual leaflet and one of three narratives: the character is waiting for the result (control narrative), had a negative result (reassurance-based narrative) or had a positive result and was successfully treated for early-stage cancer (anticipated regret-based narrative). Participants: 145 participants aged 45-65, with no CRC personal history (approved by local Ethic Committee). Measures: intention to undergo CRC screening, knowledge, risk perception, and informed choice. Analyses: Logistic regressions and ANOVAs.Findings: a) Thirteen studies were included; Most were quantitative, USA-based, recent (last 5 years). The content of the narratives varied widely. b) The reassurance-based narrative yielded to the highest intention to undergo screening (85.7% vs. no-narrative condition 51.4%, OR=5.684, p=.003; vs. regret-based condition 59.5%, OR=4.091, p=.017; vs. control narrative 66.7%, OR=3.000, p=.066). The four conditions did not differ in knowledge, risk perception, and proportion of informed choices (pu003e.578).Discussion: Our findings suggest that not all narratives are alike in promoting CRC screening, and that FOBT may be better promoted by reassurance-based narratives. Moreover, adding narratives to currently used information material did not affect knowledge, risk perception and the proportion of informed choices.

Introduction Endoscopic submucosal dissection (ESD) is an advanced endoscopic technique. In Eastern countries the learning curve is begun with gastric GI lesions carried out under expert supervision and then goes on to address esophageal and colon lesions. As Early Gastric Cancer (EGC) is a rare disease in Western countries, expert guidance is not commonly available. Methods All the ESD performed in our Endoscopy Unit in Padua from February 2012 to December 2015 including 12,552 colonoscopies were recruited retrospectively in this study. We considered the learning curve of a single endoscopist who performed 10 ESD on in vivo animal models under expert supervision before starting on human subjects. All the dissections were performed using a Hybridknife needle and ERBEJET2 (ERBE®). ESD was performed if the neoplastic lesion was considered susceptible to ESD regardless to the size. T tests for unpaired data and Pearson’s chi-test were used for statistical analysis. Results 49 ESD were performed, 28 M(57%), mean age 63 yr. The breadown was: 29 rectum (59%), 12 sigmoid tract (24%), 2 trasverse colon (4%), 4 ascending colon (8%), 2 stomach (4%). The neoplastic lesions were: 36 laterally spreading tumours (73%), 5 polypoid lesions 0 Is (10%), 4 recurrent ton scars (8%), 4 polypoid lesions 0 Isp(10%). Mean polyp area was 17.6 cm2 (range 1–70). Mean intervention time was 98 min (range 20–240). En-bloc dissection was successful in 34/49 (69%) and R0 was reached in 24/33 (72%). The histological features of the polyps were: 10 LGD (20%), 27 HGD (55%), 9 pT1 (18%), 3 pT2 (6%). The procedural complications that took place (14/49 = 28%) included: perforation during the procedure in 10/49 (20%), delayed bleeding in 3/49 (6%), rectal stenosis in 3/49 (6%). No deaths or surgical interventions followed the periprocedural complications. From the 12th procedure onwards the surgical performance became acceptable 22/27 (81%) vs 3/12 (25%) (p < 0.001). From the 30th procedure onwards the surgical performance became good 17/19 (90%, p < 0.05) and the mean execution time was significantly lower 55 vs 122 min (p < 0.0001) with no significant difference in the mean area of the lesions 15.6 vs 18.2 cm2 (p=ns). Only 3 complications occurred after the 30th procedure (p=ns). Conclusion Our findings demonstrate than an endoscopist can reach a satisfactory level of competence in ESD procedures by beginning training with in vivo animal models (at least 10 procedures) and then should go on to colo-rectal neoplasms (without size limits and no less than 12 procedures). Trainees have probably still not reached a learning curve plateau even after 40 procedures. Disclosure of Interest None Declared

Introduction NAFLD, which is increasingly and rapidly becoming the cause of liver disease in Western countries, is characterised by higher serum triglyceride and LDL levels, lower HDL levels, insulin resistance, and glucose intolerance, all crucial risk factors for the development of atherogenesis. The UK Prospective Diabetes Study (UKPDS risk engine v 2.0) and the Fatty liver index (FLI) are both validated prognostic scores for cardiovascular disease (CVD) risk and NAFLD in diabetic patients. Methods We retrospectively analysed 1902 patients attending our Diabetes Ambulatory in 2012–2013. The UKPDS risk engine and the FLI were calculated for each of these patient. Ninety-nine (19.2%) of these patients resulted at high CVD risk according to their UKPDS evaluation and underwent a complete CVD assessment (ergometric/ecostress test (EET), coronarography (CORO)). A two tailed t-test, Person’s Chi square test, and analysis of variance (ANOVA) were carried out. Results Sixty-six (59 M, mean age 68.1 y, mean disease duration 16.1 y, HbA1c > 7 prevalent) pts presented UKPDS positive/FLI > 60, 8/66 CORO+ (5 percutaneous transluminal coronary angiopathy-PTA, 3 cardiac bypass sugery-CABG, 1 peripheral transluminal angioplasty-PTA AAII) and 5 (4 M, mean age 68.6 y, mean duration disease 18.4 y, HbA1c > 7 prevalent) pts presented UKPDS positive/FLI < 20,1/5 CORO+ (1 PTCA; 1 CABG; 0 PTA, AII). In the light of this analysis, were able to pinpoint a FLI cutoff that is better able to identify, with respect to UKPDS, patients who will result positive at CORO (FLI > 52 detected 9/14 pts positive at CORO with p < 0.05). Ninety-nine pts UKPDS positive(EET negative 69.6% > 69/99) (100% > 14/14 CORO+) vs 81 pts FLI > 52 (EET negative 92.5% > 75/81) (64.2% > 9/14 CORO+). As expected, we found a significant association between CORO+ and FLI+ patients and microalbuminuria (p < 0.048), cholesterol (p < 0.020); triglycerides (p < 0.001), and LDL (p < 0.005). The only drug associated to CV risk was cardioaspirn (p < 0.003). Conclusion Study results demonstrate that FLI can be used as a marker to predict CVD risk in patients with FLI > 52. The number of patients who undergo CVD screening with a low percentage of positivity can thus be reduced. An early and aggressive treatment and monitoring program can instead be begun for type 2 diabetic patients with FLI > 52 and a reasonable suspicion of NAFLD because this population has higher risk of developing CVD events with respect to patients with FLI < 20. Disclosure of Interest None Declared