⁎3393 Benchmarking ercp performance with a prospective endoscopy database.

*3391 CLINICAL SIGNIFICANCE OF MAGNIFYING OBSERVATION USING VIDEOCOLOSCOPE FOR THE INVASION DEPTH DIAGNOSIS OF COLORECTAL NEOPLASIA. Shinji Tanaka, Ken Haruma, Shinji Nagata, Yuichi Hirota, Hirotoki Oh-e, Shiro Oka, Ryoji Takahashi, Masaki Kunihiro, Yasuhiko Kitadai, Masaharu Yoshihara, Koji Sumii, Goro Kajiyama, Hiroshima Univ Sch of Med, Hiroshima, Japan. Recent advances of magnification of videoendoscopy have enabled the detailed observation of colorectal tumor surface. The AIM of this study is to clarify the clinical significance of the pit pattern diagnosis for colorectal tumors using the magnifying videocolonoscope (CF-200Z, CF-Q240Z; Olympus or EC-410CM, EC-410ZM; Fujinon). METHODS : We examined the pit pattern of tumor surface in 342 colorectal adenomas and early carcinomas in relation to the pathologic features using above mentioned videocolonoscope with indigocarmine dye spraying or crystal violet staining methods. Regarding the pit pattern classification, we used the type (I, II, IIIL, IIIS, IV, VA and VN), reported previously by Kudo. Furthermore, we subclassified the VN pit pattern based on the non-structure area on the tumor surface into grade A (small), B (middle) and C (large). RESULTS : The cancer rate (submucosal cancer rate) in each pit pattern finding obtained from magnifying colonoscopic observation was IIIL 49/150: 33% (2%), IIIS 15/36: 42% (3%), IV 16/30: 53% (3%), VA 53/58: 91% (19%), VN 35/39: 90% (80%), respectively. The incidence of submucosal massive cancer in V pit pattern was VA 3/58 (5%), VN 31/39 (80%), respectively. On the other hand, according to our new classification, submucosal massive cancer rate in each Grade A, B and C of VN pit pattern is 3/8 (38%), 16/17 (94%) and 14/14 (100%), respectively. CONCLUSION : Pit pattern diagnosis using magnifying videocolonoscope for colorectal tumor is useful in the histologic diagnosis and invasion depth prediction. Especially, Grade B and C of VN pit pattern are the definite indicators of submucosal massive colorectal carcinoma that can’t be indicative for the curative endoscopic resection. *3392 REFEEDING PATIENTS AFTER ENDOSCOPIC SPHINCTEROTOMY: WAITING OR NOT WAITING ? Philippe Bellon, Nathalie Lesavre, Marc Barthet, Nicolas Barriere, Ariadne Desjeux, Jean-Charles Grimaud, Jacques Salducci, Hosp Nord, Marseille, France. Background: After endoscopic sphincterotomy, refeeding is usually delayed for 1 or 2 days after ERCP. The aim of this study was to investigate the necessity of delayed refeeding in patients undergoing endoscopic biliary or pancreatic sphincterotomy (EBPS). Methods: From November 1998 to September 1999, 60 patients with previous normal alimentation were prospectively randomised after EBPS in two groups. Patients belonging to the goup A were allowed for early refeeding (6 hours delayed) whereas patients belonging to the group B were asked to wait the following day before refeeding. Results: The two groups were comparable for age (67 vs 66 years old), levels of serum amylase and lipase before ERCP, indication of ERCP (pancreatic cancer, common bile duct stone, cholangitis, sphincter of Oddi dysfunction, acute or chronic pancreatitis). No difference could be shown concerning the precut papillotomy rate, the biliary or pancreatic stenting rate, the rate of removed choledocal stones, the need for endoscopic hemostasis. Two patients (one in each group) were excluded few hours after randomisation for severe acute pancreatitis. 16 (27.6 %) out of the 58 remaining patients suffered from abdominal pain after ERCP. 13 of them healed with paracetamol infusion and 3 needed morphinic infusion. The paracetamol consumption in group A was significantly lower than in group B (2 vs 11, p = 0.007). In group A, no patient suffered from nausea or vomiting and only one experienced pain during refeeding, requiring paracetamol administration. No statistical difference was shown regarding to the serum level of amylase and lipase after ERCP. The duration of hospital stay was decreased in patients with early refeeding without reaching statistical significance (group A: 2.9 days and group B: 4.1 days, p = 0.15). Conclusion: Early refeeding is well tolerated and decreases significantly the need for paracetamol after endoscopic sphincterotomy. A trend toward a decrease of the duration of the hospital stay was observed in this study. *3393 BENCHMARKING ERCP PERFORMANCE WITH A PROSPECTIVE ENDOSCOPY DATABASE. Peter B. Cotton, James A. Vaughan, Alan Barkun, Paul Jowell, Joseph Leung, Eric Libby, Nick Nickl, Stephen Schutz, Med Univ of South Carolina, Charleston, SC; McGill Univ, Montreal, Canada; Durham VA

AB80

GASTROINTESTINAL ENDOSCOPY

Med Ctr, Durham, NC; Univ of CA, Davis, Sacramento, CA; Tufts New England Med Ctr, Baston, MA; Univ of Kentucky, Lexington, Lexington, KY; Wilford Hall, USAF Med Ctr, Lackland AFB, TX. Benchmarking endoscopic activity is of increasing interest to professional societies, payers and patients, allowing identification of major variations in performance as a guide to improvement. Seven centers have used a single endoscopy reporting database (GI-Trac) for various periods since 1994, and have accumulated data on 8,094 ERCP procedures. Data are entered directly by the endoscopist, immediately after the procedure. We compared activities by center (not by individual endoscopists), for markers of overall activity, data quality, case complexity, and technical success. These data (table)show considerable variations in the spectrum of ERCP practice and quality of data entry. Technical success rates are consistently high, with some trend towards higher success with larger volumes. Further analyses by individual endoscopists and practice volume will lead to specific insights and recommendations. In the future, endoscopists and centers will be at a disadvantage if unable to provide similar performance data.

Center total cases annual volume 1997 normal/no conclusion % data completeness % out of time range stone not measured technical success % (n) bile duct in jaundice biliary stone extraction minor papilla cannulation pancreatic stent insertion complication % (n) in bile duct stones

1

2

3

4

6

7

380

938

3878

405

1006

736

751

61

308

1068

215

353

287

231

7

8

4

3

10

19

14

7 7

1 18

5 3

10 3

16 1

68 5

15 2

97 (129) 68 (73) 80 (5) 100 (5) 5 (74)

96 (282) 90 (151) 73 (64) 75 (8) 5 (136)

94 (281) 87 (111) 77 (40) 94 (16) 6 (124)

93 (161) 90 (81) 51 (57) 80 (30) 6 (101)

93 (156) 84 (38) 40 (20) 100 (4) 0 (54)

89 (311) 84 (191) 73 (26) 100 (3) 8 (194)

98 (882) 91 (361) 86 (539) 95 (269) 4 (429)

5

*3394 SAFETY OF ENDOSCOPIC TREATMENT FOR NON VARICEAL BLEEDING: A META-ANALYSIS. Riccardo Marmo, Gianluca Rotondano, Maria Antonia Bianco, Roberto Piscopo, Livio Cipolletta. The efficacy of endotherapy in upper nonvariceal GI bleeding is largely documented.Different procedures have different efficacies, but their safety has not been sistematically evaluated.For a treatment to be recommended, both its efficacy and safety must be known.We therefore assessed the safety of the most popular (injection therapy) and that of the most effective (thermal therapy) endoscopic treatment. Explicit inclusion and exclusion criteria were defined a priori. On-line search through MEDLINE (January 1990-November 1999) as well as manual search (references of published studies and congress proceedings)were performed. A total of 153 papers were traced. Five papers could be included in the meta-analysis with a total of 543 patients. See table for results. Induced bleeding was the most frequent and clinically relevant undesired event in patients treated with thermal therapy. All induced bleedings were not life-threathening and were managed conservatively. No perforation or death was induced with epinephrine injection, whereas these events were observed in 3 and 1 patients respectively with thermal therapy. Effectiveness of thermal therapy should always be weighed against the not infrequently induced bad outcomes and the costs related to the management of such complications.

OUTCOME

THERMAL

INJECTION

INDUCED

(%)

(%)

ARR

NNH

95%

7.3 1.1 0.036

5.9 0 0

1.4 1.1 0.036

72 91 278

18 to ∞ 43 to ∞ 88 to ∞

BLEEDING SURGERY DEATH

CL

ARR: absolute risk reduction. NNH: number need to harm

VOLUME 51, NO. 4, PART 2, 2000