Abstracts of the 24 th National Congress of Digestive Diseases / Digestive and Liver Disease 50/S2 (2018) e63–e238 e205 P.08 Endoscopy 2 P.08.1 VIDEOCAPSULE ENDOSCOPY FOR DETECTING A SOURCE OF BLEEDING IN IRON DEFICIENCY ANEMIA: PERFORMANCE AND RISK FACTORS A. Contaldo * , G. Losurdo, F. Albano, A. Iannone, E. Ierardi, M.B. Principi, A. Di Leo Section of Gastroenterology, University of Bari, Bari, Italy Background and aim: Iron deficiency anemia (IDA) may affect 1–2% of all adults in Western society. After conventional endoscopy, the cause of IDA remains unknown in up to 40% of patients. Nowadays video-capsule endoscopy (VCE) represents the cornerstone of inves- tigation for unexplained IDA in subjects with suspicion of obscure bleeding. Our aim was to investigate the prevalence of VCE-detected small bowel injury and associated risk factors in a cohort of inpatients with IDA and obscure small-bowel bleeding. Material and methods: We enrolled inpatients with IDA (hemoglobin <12.0 g/dl in women and <13.0 g/dl in men), referred to our ter- tiary Unit, which had obscure bleeding demonstrated by fecal occult blood test and negative upper endoscopy and colonoscopy. Patients with cirrhosis and inherited polyposis syndromes were excluded. A complete medical history (medications and comorbidities) and lab- oratory tests were collected. All subjects received VCE (PillCam SB2 or SB3). Unpaired T-test and Fisher’s test were used for univariate analysis. Variables with statistical significance at univariate analysis were evaluated by a multivariate binomial logistic regression analy- sis. The risk was expressed with Odd Ratio (OR) and 95% confidence intervals (CI). Results: One hundred and five patients (female: male ratio 51:54, aging 62.0±16.8 years) were recruited according to exclusion and inclusion criteria. In particular all patients had hemoglobin levels <10 g/dl and had strong clinical suspicion of obscure bleeding. Seventy six (72.4%) presented one or more small bowel lesions at VCE. When compared to patients without small bowel injury, subjects with lesions were older (64.4±17.7 versus 59.0±21.5 years), had a longer small bowel transit time (6.2±2.9 versus 5.2±2.1 h) and had used non steroidal anti-inflammatory drugs for at least two weeks (17.1% versus 0%) at univariate analysis. However, at multivariate analysis only young age was a protective factors against small bowel damage (OR=0.97, 95% CI: 0.94–0.99, p=0.04), while non steroidal anti-inflammatory drugs consumption (OR=8723, 95% CI: 0.001–96850, p=0.99) and small bowel transit time (OR=0.88, 95% CI: 0.73–1.06, p=0.17) were not statistically significant. In 29 (27.6%) patients a source of bleeding explaining the anemia was not found. Conclusions: VCE can reveal a source of obscure bleeding in unex- plained IDA in up to 75% of subjects and, therefore, it is a mainstay of diagnostic workup in selected patients. Old age is the main risk factor for small bowel lesions. P.08.2 EUS-GUIDED CHOLEDOCHODUODENOSTOMY USING A LUMEN APPOSING METAL STENT FOR MALIGNANT DISTAL BILIARY OBSTRUCTION: A RETROSPECTIVE ANALYSIS OF A SINGLE CENTER EXPERIENCE A. Anderloni * , A. Fugazza, F. Auriemma, S. Carrara, M. Di Leo, R. Maselli, E. Troncone, E.C. Ferrara, P.A. Galtieri, R. Semeraro, F. D’Amico, S. Attardo, A. Repici Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano (MI), Italy Background and aim: Endoscopic ultrasonography guided chole- dochoduodenostomy (EUS-CD) using a lumen apposing stent has been recently reported as an alternative approach in patients with malignant obstructive jaundice and failed endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to evaluate the safety, technical and clinical efficacy of this procedure in this kind of patients. Material and methods: Retrospective analysis of a prospectively maintained registry of consecutive patients with unresectable ma- lignant distal bile duct obstruction who, (October 2015–October 2017), underwent EUS-CD using the study device (Hot-AXIOS, Boston Scientific Corp., Natick, Massachusetts, USA) after unsuc- cessful ERCP in a single tertiary-care academic medical center. Technical success was defined as accurate positioning of the stent. Clinical success was defined as resolution of biliary obstructive symptoms with a decrease in the total bilirubin level to 50% reduction of the initial level. Results: Thirty-five patients (19M/16F; median age 71.3±12.4) un- derwent direct EUS-CD using the biliary Hot AXIOS (diameter 6x8mm in 16 (45.7%) patients; 8x8mm in 13 (37.2%) patients; 10x10 mm in 6 (17.1 patients). ERCP failure was due to inability to get deep biliary cannulation in 24 patients (68.6%) and to duodenal obstruction in the remaining 11 patients (31.4%). The procedure was technically successful in 33/35 patients (94.3%) (mean procedural time of 37.9 min (range 10–104)). Stent placement failed in 2 cases (5.7%). Thirty-five patients (19M/16F; median age 71.3±12.4) underwent direct EUS-CD using the biliary Hot AXIOS (6 mm in 16 (45.7%); 8 mm in 13 (37.2%); 10 mm in 6 (17.1%). ERCP failure was due to inability to get deep biliary cannulation in 24 patients (68.6%) and to duodenal obstruction in the remaining 11 patients (31.4%). The procedure was technically successful in 33/35 patients (94.3%) (mean procedural time 37.9 min (range 10–104)). Stent placement failed in 2 cases (5.7%). Clinical success was achieved in 31/33 patients (93.9%) with a reduction in the total bilirubin level of 63.42%. The median post- procedure hospitalization was 5.64±6.73 days. The mean FU was 105 days (range 17–411). During FU 11 patients died because of disease progression. Major complications occurred in 5 patients (16.1%) after a mean of 69.5 days (range 17–148 d): 1 fatal bleed- ing 17 days after stent placement; 3 stent occlusion due to food impact leading to cholangytis, 1 spontaneous migration requiring re-intervention. Conclusions: This study shows that EUS-CD using the Hot AXIOS delivery system is associated with high technical and clinical suc- cess rates. The rate of complications including one fatal event is not negligible and should be carefully considered before using the stent in this clinical setting. Future prospective comparative studies are required to fully assess the long-term efficacy and safety of the stent. P.08.3 MULTIPLE PLASTIC STENT (MPS) VERSUS FCSEMS FOR MANAGING POST LIVER TRANSPLANTATION BILIARY STRICTURE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIAL A. Tringali * , G. Bonato, M. Cintolo, L. Cristoferi, E. Forti, L. Dioscoridi, F. Pugliese, M. Mutignani ASST Grande OSpedale Metropolitano Niguarda, Milano, Italy Background and aim: Anastomotic stricture (AS) post liver trasnplas-