⁎3388 Endoscopic treatment with argon plasma coagulation for portal hypertensive gastropathy.

*3387 YIELD OF PANENDOSCOPY AND COLONOSCOPY FOR IRON DEFICIENCY IN POST-GASTRECTOMY PATIENTS. Gordon C. Hunt, Douglas O. Faigel, Oregon Health Sci Univ, Portland, OR; Portland VA Med Ctr, Portland, OR. Intro: Iron (Fe) deficiency is a well documented late complication of partial gastrectomy (PG). The yield of endoscopy in the evaluation of Fe deficient PG patients is unknown. Aim: Determine the utility of panendoscopy (EGD) and colonoscopy (CSP) in Fe deficient patients with prior Billroth I (B-I) or Billroth II (B-II) gastrectomy compared to non-PG patients. Methods: Patients with prior PG who had CSP and/or EGD for evaluation of Fe deficiency were identified and compared to a control (cont) group of Fe deficient patients without history of gastric surgery. The two groups were retrospectively identified using the CORI (Clinical Outcomes Research Initiative) database, between periods of 6/1/96 and 7/31/99 at Oregon Health Sciences University and the Portland VAMC. Patients with a ferritin ≤ 50 µg/L or a transferrin saturation (%sat) ≤ 20% were included and their records reviewed. Patients were excluded for prior gastric surgeries other than a B-I or B-II. Laboratory data included hemoglobin, hematocrit, mean corpuscular volume, ferritin, and %sat. Colonoscopic findings of tumor, polyps ≥1 cm, angiodysplasia >5 in number, active colitis, or colonic ulceration were recorded. The presence of any adenomatous polyp (regardless of size) was also noted. EGD findings evaluated were ulcers, esophagitis, or esophageal/gastric varices (Vxs). Fisher’s exact test and Student’s T-test were used for statistical analysis. Results: 52 PG patients (35 CSP, 52 EGD) and 53 controls (44 CSP, 53 EGD) were studied. There were 13 BI and 39 BII patients. Mean interval between PG and endoscopy was 22 yr (range 4-46 yr). Demographics and laboratory values were not significantly different between PG and cont groups. Mean ferritin levels were similar (PG=20.6, cont=23.4 µg/L, p=0.3). There were no significant differences (p>0.05) in the proportion of patients with polyps ≥1 cm (PG=9%, cont=7%) or any adenomatous polyps (PG=29% vs 18%). No patient had malignant colonic tumors, active colitis, or significant colonic angiodysplasia. Two patients with PG had colonic ulcers, versus no control patients. Comparing EGD findings, there were no significant differences between groups for the presence of ulcers (PG=14% vs 23%), esophagitis (PG=12% vs 13%), Vxs (PG=4% vs 6%), or presence of any of these three lesions (PG=25% vs 38%). There were no upper GI malignancies. Conclusions: The yield of EGD and CSP is similar in PG and non-PG Fe deficient patients. The endoscopic evaluation of Fe deficiency should not differ in patients with PG. *3388 ENDOSCOPIC TREATMENT WITH ARGON PLASMA COAGULATION FOR PORTAL HYPERTENSIVE GASTROPATHY. Begona Gonzalez, Candid Villanueva, Montserrat Planella, Jose M. LopezBalaguer, Jose M. Dedeu, Cristina Gomez, Xavier Torras, Joaquin Balanzo, Hosp Sant Pau, Barcelona, Spain. Portal hypertensive gastropathy (PHG) is a rare but relevant cause of gastrointestinal bleeding for which few options of medical therapy are available. Argon plasma coagulation (APC) is an endoscopic method of non-contact electrocoagulation which can be delivered by tangential application and has only limited deep of penetration. Subsequently, APC appeal for treating widespread vascular disorders such as PHG. The aim of this study was to assess the efficacy of APC for the treatment of chronic bleeding from PHG which did not respond to the pharmacological therapy of portal hypertension. METHODS: 9 patients with cirrhosis (Pugh class A/B in 3/6 and posthepatitic etiology in 6) were included. All had PHG with recurrent bleeding despite iron therapy plus isosorbide mononitrate alone (in 4 cases with intolerance to β-blockers) or combined with nadolol (3 cases) while 2 patients had no previous treatment. APC was delivered by multiple and brief pulses applied over wide areas of visible angioectasias. Sessions were performed every 2 to 3 weeks. PHG was diffuse in 4 cases and mainly antral in 5. RESULTS: a median of 6 sessions of APC were performed (range 4 to 12) during a mean period of 6±4 months. The mean follow-up was of 28±12 months. Hemoglobin value significantly improved after APC (from 76±13 to 106±19 G/L, P= 0.006) although iron therapy could be discontinued only in 1 case. Transfusional requirements decreased from a median of 4 (range 2 to 13) Units of Red Cells in the 12 months before APC to 0 (0 to 4) during the 12 months after starting APC (P=0.001). The endoscopic severity of PHG (graded from 1 for mild, to 3 for severe) also improved (from 2.9±0.3 to 2±0.5, P=0.002). There were no serious complications due to APC (3 patients complained of transient pain). Only 1 patient died 18 months after APC due to liver failure. CONCLUSIONS: endoscopic therapy with APC is a safe and effective treatment for PHG which do not respond to the pharmacological therapy of portal hypertension. In these patients APC should be considered before more aggressive approaches

VOLUME 51, NO. 4, PART 2, 2000

*3389 AGE LINKED GUIDELINES FOR OPEN ACCESS ENDOSCOPY ARE THEY JUSTIFIED ? EXPERIENCE OF 1000 PATIENTS. Robert Boulton-Jones, Mark C. Follows, Sam S. Chatterjee, Alaa E. Mahmoud, KINGS MILL Hosp, Nottingham, United Kingdom. Introduction It is unclear whether early detection of significant upper GI lesions or cost effectiveness is the primary objective of open access endoscopy (OAE) . The best method of managing younger patients with dyspepsia without alarm symptoms is disputed and it is debatable whether OAE is appropriate in all patients. Aims (a) To audit the diagnostic yield of OAE (b) To compare the diagnostic yield in younger patients (less than 45 years of age - group 1) to older patients ( more than 45 years of age - group 2). (c) To assess the incidence of gastric and oesophageal malignancy in relation to age and alarm symptoms. Methods Data from 1000 consecutive OAE referrals from January 97 to May 99 were prospectively collected. The indication for endoscopy,age, sex, duration of symptoms, results of upper GI endoscopy and biopsy findings were analysed Results : Table 1 Conclusions a- 2/3 of open access endoscopy yield a positive finding, but a large number of patients have minor pathology. b- Our results suggest that OAE is not a good tool to pick up gastric or oesophageal carcinoma in patients without alarm symptoms.c- Excluding malignancy ( which could be easily identified from alarm symptoms in the majority of patients) , The pick up rate of pathology is similar in different age groups which would unjustify the use of age based guidelines for open access endoscopy. d- The effectiveness of OAE has therefore to be assessed in terms of cost effectiveness rather than the ability to detect significant pathology.

Pathology detected in different age groups Diagnosis Number Normal Oesophagitis Peptic ulcer Other diagnosis* Cancer**

All referrals 1000 32.3% 29.5% 4.7% 36.4% 1.7%

Group 1

Group 2

263 35.4% 33.4% 6% 31.1% 0

737 31.2% 28.1%% 4.2% 28.3% 1.7%

*Gastritis, duedinitis, HH and Barretts. **13/17 patients presented with alarm symptoms & 12/17 patients were inoperable. *3390 ROLE OF EARLY ERCP AND SPHINCTEROTOMY IN THE MANAGEMENT OF ACUTE PANCREATITIS. Aasim M. Sheikh, Steve Warshafsky, David C. Wolf, Edward Lebovics, VA Med Ctr, Birmingham, AL; Westchester Med Ctr, Valhalla, NY. Background: The role of early ERCP ± endoscopic sphincterotomy (ES) in patients with acute pancreatitis of biliary origin remains controversial. The aim of this study is to pool the conflicting results of various studies through a systematic review and to show if early ERCP (within 72 hrs) as compared to conservative management decreases the risk of both local and systemic complications and of death from acute biliary pancreatitis. Methods: Using Medline, from the years 1985-1997, along with a manual search of abstracts from major national conferences, and screening the references of the published studies and reveiws, controlled trials were identified in which early ERCP ± ES were used in the management of acute biliary pancreatitis (ABP). Five controlled trials were identified. Out of these two were excluded; one each for lack of randomization and for availability of data in abstract form only. Data from remaining three trials for all patients (n=470) in both treated (n= 243) and control groups (n=227) with suspected ABP were pooled using a fixed effects model (Mantel - Haenszel method) and assessed for the three main outcomes, i.e. mortality (in-hospital and upto 3 months), systemic complications (respiratory failure, renal failure, shock, DIC) and local complications (pancreatic abscess, phlegmon, psuedocyst, hemmorhagic pancreatitis and acute cholangitis). Results: The individual (for each study) and pooled estimates for all three outcomes were expressed as Mantel - Haenszel weighted odds ratios (O.R.) and presented in a standard meta-analysis plot (here in a tabulated form) with confidence intervals (CI) of 95%. Conclusions: Early ERCP and endoscopic sphincterotomy in acute biliary pancreatitis greatly decreased the risk of local complications. The effect on systemic complications and mortality is inconclusive and requires a further study ERCP ± ES Mortality Complications: Systemic Local

Conservative

O.R. (CI 95%)

11/243

14/227

0.73 (0.3-1.75)

31/243 20/243

37/227 56/227

0.87 (0.5-1.48) 0.37 (0.2-0.62)

GASTROINTESTINAL ENDOSCOPY

AB79