e214 Abstracts of the 23 rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223 the use of CEUS as guidance technique for abdominal biopsy has been quantified. In experienced hands such a procedure seems to have limited indication (2.4% of 3857 biopsies), but represents a powerful tool to cope with challenging scenarios such as poorly visualized or invisible lesions sampling of non-necrotic areas in the target lesions andrepeat biopsy after unsuccessful sampling performed using the standard unenhanced technique. P.12.7 MANAGEMENT OF RESECTION AND INTRA-PROCEDURAL COMPLICATIONS OF LARGE COLONIC LESIONS IN A REAL-LIFE SETTING: THE SCALP STUDY A. Amato ∗,1 , F. Radaelli 1 , V. Cennamo 2 , E. Di Giulio 3 , L. Fuccio 4 , G. Manes 5 , O. Tarantino 6 , G. Fiori 7 , M. De Bellis 8 , A. Buda 9 , F. Pigò 10 , P. Cesaro 11 , G. Feliciangeli 12 , P. Dulbecco 13 , A. Musso 14 , G. Gullotti 15 , M. Giardini 16 , B. Mangiavillano 17 , C. Hassan 18 , A. Repici 19 1 Ospedale Valduce, Como, Italy; 2 Ospedale Bellaria, Bologna, Italy; 3 Ospedale Sant’Andrea, Roma, Italy; 4 Policlinico Sant’Orsola, Bologna, Italy; 5 Ospedale Salvini, Garbagnate, Italy; 6 Ospedale San Giuseppe, Empoli, Italy; 7 Istituto Europeo Oncologico, Milano, Italy; 8 Istituto Nazionale Tumori, Napoli, Italy; 9 Ospedale Santa Maria del Prato, Feltre, Italy; 10 Ospedale Civile, Modena, Italy; 11 Fondazione Poliambulanza, Brescia, Italy; 12 Ospedale di Macerata, Macerata, Italy; 13 Università degli Studi, Genova, Italy; 14 Città della Salute e della Scienza, Torino, Italy; 15 Policlinico G. Martino, Messina, Italy; 16 Ospedale di Urbino, Urbino, Italy; 17 Humanitas Mater Domini, Castellanza, Italy; 18 Ospedale Nuovo Regina Margherita, Roma, Italy; 19 Humanitas University, Milano, Italy Background and aim: Endoscopic resection of large colonic lesions (LCLs, >20mm) is effective and it is associated with an accept- able incidence of incomplete resection and complications when performed by appropriately trained endoscopists in resourced en- doscopy centers. There are scanty data on the management of these lesions out of referral centers. Aim of the study is to evaluate the management of endoscopic resection of LCLs and intra-procedural complications in a real-life setting. Material and methods: In a prospective, multicenter, observational studies conducted in 20 centers, data from consecutive endo- scopic resections of LCLs performed over a 6-months period were collected through a web database. All patients undergoing LCLs re- section were enrolled at procedure-time and followed-up at 15 days for adverse events and at 6 months for endoscopic and histological recurrence. Results: 1076 LCLs (mean size 30.5 mm, SD 12.3; 41.2% lateral spreading tumor, 28.4% sessile, and 30.4% pedunculated) removed in 979 patients (59% males, mean age 66±11.7 years) were analyzed. Preliminary data on pre-procedure management and intra-procedural complications are presented. A piecemeal endo- scopic mucosal resection (EMR) was performed in 37.5%, en-bloc EMR in 20.5%, snare polypectomy in 34.6%, underwater EMR in 1.1% and endoscopic submucosal dissection in 6.3% of the lesions. The resection of the LCLs was not performed at diagnosis-time in 50.2% of the cases. Reasons for deferral were time constrains (38.4%), limited endoscopist expertise (22.8%), concomitant antithrombotic therapy (ATT) (9.1%) and endoscopist’s preference for hospitaliza- tion (29.7%). Of patients with LCLs, 19.6% were on ATT (62.3% aspirin, 12.3% thienopyridines, 4.9% dual antiplatelet, 15.4% vitamin K antagonists [VKAs], 5.1% direct oral anticoagulants [DOACs]). Aspirin and/or thienopyridines were withhold before resection by 53.6% and 91.7% of patients, respectively. Overall, intra-procedural bleeding requiring endoscopic therapy occurred in 9.2% of patients of whom 28.2% were on ATT, which had been withheld in all the cases but 50% of patients on aspirin. After endoscopic treatment all patients recovered uneventfully. Overall, perforation occurred in 0.7% of patients; 75% of them were successfully managed endoscopically. Conclusions: The management of resection of LCLs varies widely. The incidence of intra-procedural complication is not negligible but the endoscopic management is successful in most of the cases, even in a real life setting. P.12.8 META-ANALYSIS: ASPIRIN EXPOSURE AND CLINICALLY SIGNIFICANT DELAYED BLEEDING AFTER COLORECTAL POLYPECTOMY F. Pigò ∗ , H. Bertani, G. Grande, R. Conigliaro Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy Background and aim: To assess the risk of clinically significant delayed bleeding in patients who underwent to colorectal polypec- tomy in relation to aspirin exposure. Material and methods: Relevant publications were identified in MEDLINE/EMBASE/Cochrane Central Register for the period 1966– 2016. Studies in which aspirin exposure and bleeding rate were specified were included in the study. Risk of post-polypectomy bleeding, also in relation to dimension of the polyp was extracted. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was produced based on random effect models (Fig. 1, see p. e215). I2 statistic was used to describe the variation across studies due to heterogeneity. Results: 11 studies (4 prospective and 7 retrospective) including 9307 patients were comprised in the analyses. Overall, 344 patients (pooled OR 1.7, 95% CI 1.1% to 2.7%, I2 = 51.3%) experienced rectal bleeding after polypectomy with ongoing aspirin. Subgroup analy- sis (1 prospective and 1 retrospective studies with lesions ≤2cm) exposed the safeness of polypectomy and the aspirin not withheld for lesions ≤20 mm (OR 0.8, 95% CI 0.4% to 1.7%, I2 = 50.9%). Conclusions: Colorectal polyectomy is safe under aspirin for polyp ≤2 cm. P.12.9 COST ANALYSIS AND OUTCOME OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR COLORECTAL LESIONS IN OUTPATIENTS VERSUS INPATIENTS R. Maselli ∗ , P.A. Galtieri, A. Fugazza, G. Lollo, L. Poliani, R. Semeraro, F. Auriemma, G. Amvrosiadis, M. Di Leo, E.C. Ferrara, S. Carrara, A. Anderloni, A. Repici Humanitas Research Hospital, Rozzano (MI), Italy Background and aim: Endoscopic submucosal dissection (ESD) is worldwide accepted as a minimally invasive treatment for early gastrointestinal (GI) cancer but it is still considered a challenging and risky procedure in the colorectum. In both Eastern and Western settings published studies indicate that the vast majority of patients undergoing ESD are hospitalized because of the expected high risk of complications. Aim of this study is to compare costs in the endo- scopic management of colorectal ESD in outpatients and inpatients and investigate the safety and efficacy of procedure performed in outpatient setting, in a tertiary level center. Material and methods: This is a retrospective observational study which included included 126 patients consecutively treated by ESD at Humanitas Research Hospital, Italy from May 2014 to March 2016. Patients were divided into 2 groups: outpatients (group A), discharged in 1 d and inpatients (group B) that were admitted in