Abstracts Sl93 PO.78 PRIMARY SMALL BOWEL MELANOMA: COLOR-DOPPLER US, CT AND RX FINDINGS L. Tarantino'!, V. Nocera 2, F. Montanaro 3, M. Perrotta 4 , G. Balsamo 5, E. Rossi 2, R. Mamone 2 , I.F.M. Sordelli 6, P. Sperlongano 6 ! Interventional US Unit, S. Giovanni di Dio Hospital - ASIJVA3, Frattarnaggiore (NA) 2Radiologia, S. Giovanni di Dio Hospital- ASIJVA3, Frattarnaggiore (NA) 3S. Giovanni di Dio Hospital - ASIJVA3, Frattarnaggiore (NA) 4Division of Surgery, S. Giovanni di Dio Hospital - ASIJVA3, Frattarnaggiore (NA) 5Division of Medicine, S. Giovanni di Dio Hospital - ASIJVA3, Frattarnaggiore (NA) 6V Division of Surgery, II University ofNaples, Naples Background and aim: We report a case of Primary Small Bowel Melanoma and show Color-Doppler-Ultrasound (CDUS), enhanced Computed tomography (Cn and barium enhanced radiography (Rx) findings. Material and methods: Female, 49 years old, admitted because of weakness, nausea, epigastric pain, chronic anaemia and loss of weight. On admission, clinical examination of heart, chest and abdomen was normal. Laboratory investigation confirmed a sideropenic anaemia (blood haemoglobin: 8.2 g/dl). Tumor markers (CEA, Ca 19-9, Ca-125, AFP, NSE, TPA) were negative. Chest X-ray and Gastroscopy were normal. CDUS, performed on the same day, showed a hypervascular, hypoechoic mass (diameter: 7x6x 5 em) iu the left upper abdomi- nal quadrant with a satellite hypoechoic nodule (diameter: 19 mm). The diagnosis of carcinoma of the transverse colon with lymphnodal metastasis was suggested. Howewer, a full colonoscopy failed to show any large bowellesiou. Abdominal enhanced "single-slice"CT (Atom Fast Ring, Hitachi, Japan; oral C.m.: Gastrografin, Schering, Germany; i.v. c.m.: lomeron 400, Bracco, Italy) demonstrated a unhomogeneous well defined jejunal mass with central contrast enhancement in venous phase. The diagnosis oflymphoma orleiomioma was suggested. Single- contrast Rx (oral c.m.: Prontobario, Bracco, Italy) showed stretched and distended jejunal loops proximal to a narrowed jejunal lumen caused by au intramural mass. Results: The patient underwent resection of the involved jejunal loop together with 3 enlarged mesenteric limphnodes. Macroscopically, in resected jejunum, a polypoid mass (diameter: 7.5 em) was found. Histologically, the tumor consisted of: epithelioid cells with irregular nuclei and eosinophilic cytoplasma, containing dark brown pigment and infiltrating lymphatic vessels. At immunochemistry, marked positivity for S100 and focal positivity for HMB45 antigens were present. A single limphnode was positive for malignancy. The definitive diagnosis was: Melanoma of the small bowel with lymphnodal metastasis. Anam- nesis of the patient was negative for any previous cutaneous or mucosal surgery. Conclusions: Primary jejunal melanoma is a reliable diagnosis in this case. CT and X-ray could exactly identify the site were the tumor orig- inated. Howewer, only US detected metastatic mesenteric lymphnode before surgical excision. PO.79 COLORECTAL CANCER SCREENING: METHODOLOGY OF A NATIONAL SURVEY FOR COLONOSCOPY COST ANALYSIS G. Pippa!, A. Federici *,2, E. Di Giulio!, M. Ferrara!, A. Rossi!, F.S. Mennini 2, F. Palazzo 2 , G. Durante 2, A. Ricciardi 2, S. Valle 2, P. Borgia 2 , G. Guasticchi 2 !SIED (Societii ltaliana Endoscopia Digestiva), Rorna 20VE, Osservatorio per la Valutazione Economica dei Programmi di Screening e delle Tecnologie in Sanitii Pubblica, Rorna Background and aim: The colonoscopy (CS) is one of the most impor- tant procedure of CRC screenings because is used both as a screening test and as a follow-up test. Moreover CS represeuts a very expensive test in CRC screening. However, in Italy Cost Benefit Approach were carried out rarely, and few Cost Analysis exist to evaluate CS direct costs. For these reasons, the Italian Society for Digestive Endoscopy (Societa Italiana di Endoscopia Digestiva, SlED) jointly with the Centre of Technology Assessment in Public Health (CTAph), a Research Uuit of the Agency for Public Health of Lazio Region (Agenzia di Sanita Pubblica, ASP), projected a survey for the CS cost items measuremeut and assessment. Material and methods: A multidisciplinary Working Group (WG), composed by gastroenterologists, epidemiologists, health economists and informative system experts has been established in May 2005 by SlED aud CTAph to realize a questiounaire for the survey. At the end of September after many meetings the WG reached a consensus on a final version. It was sent by Internet to all the SlED members; deadline was established in November 2005. To complete the direct cost assessment, WG provided to contact a selected number of centres, for a in-depth study. The aim of this focus is the collection of additional data (monetary cost and cost resource). Therefore a Delphi survey will be performed on the duration of procedures and results will be used in a Sensitivity Analysis. Results: The questionnaire asked information about colonoscopies performed in the year 2004 and it has been structured into seven sections: 1) number of CS for each type; type of admission; number of complete, partial and repeated CS; 2) type of administred sedation; 3) complication incidence; 4) type of intestinal toilet; 5) drugs for deep and conscious sedatiou; 6) staff employed and mean time dedicated to CS; 7) materials and technical equipment. Compilers also provided information on endoscopy Unit. When real data were not available, estimations were required. The questionnaire permitted to quantify the resources. Monetary evaluation will be calculated indirectly through an in-depht study. Conclusions: The data collected will be used for a CS Cost Aualysis. Moreover the iuformations will be used by Public Health authority within a cost-effectiveness analysis to individualize the CRC screening strategy with the best cost-effectiveness ratio. PO.80 SCREENING COLONOSCOPY IN FIRST·DEGREE RELATIVES OF PATIENTS WITH COLORECTAL CANCER: A FEASIBILITY STUDY IN LAZIO REGION A. Federici *, S. Valle, G. Durante, P. Giorgi Rossi, D. Baiocchi, A. Barca, P. Borgia, G. Guasticchi ASp, Agenzia di Sanitii Pubblica della Regione Ulzio, Rorna Background and aim: Colorectal cancer (CRC) patients' relatives are considered to be at increased risk of CRe. The objective of the present study is to assess feasibility of a screening program by colonoscopy (CS) in first-degree relatives of new diagnosed CRC patients. Material and methods: The study was conducted from October 2003 to June 2004 in 13 Hospital of Lazio region that prospectively enrolled