M1530: Early Precut Prevents Post-ERCP Pancreatitis: A Meta-Analysis of Randomized Controlled Trials

Abstracts CRC in this patient population. Our purpose was to determine the yield of CRC screening in this younger group compared to a control group over the age of 50.Methods: We reviewed the results of all colonoscopy exams performed at Temple Hospital from 2007-2008. We selected all complete colonoscopy exams with at least a good prep performed in average risk African American patients between the ages of 45-49. We excluded patients with signs or symptoms of CRC as well as those with a family history of CRC. We selected two controls for each case: asymptomatic average risk African Americans between the ages of 50-59 who completed a good quality colonoscopy during the same time period. Controls were selected based on alphabetical order.Results: We identified 109 patients age 45-49 years and 226 patients age 50-59 who underwent screening colonoscopy. No cancers were found in either group. The younger group had a similar BMI (31.5 vs. 31.2; P⫽0.74) and gender composition (% females 55.4 vs. 61.4; P⫽0.28) to the older group. The prevalence of adenomatous polyps of any size was similar for both younger and older patients (22.3 vs. 19.7%; P⫽0.57) as was the prevalence of polyps containing villous features (2.7 vs. 1.3%; P ⫽ 0.39). However, younger patients were found to have a higher frequency of polyps with high grade dysplasia (4.5 vs. 0.4%; P ⫽ 0.03). The prevalence of right sided polyps (proximal to the splenic flexure) was approximately 10% in both groups (P⫽0.89). In patients with adenomas, the prevalence of more than one polyp was approximately 30% in both groups (P ⫽ 0.32). Patients from the ages 50-59 group were more likely to drink alcohol (43.3 vs. 21.5%; P⬍0.001), smoke (47.6 vs. 37.4%; P⫽ 0.03) and consume aspirin (26.1 vs. 13.5%; P⫽0.01) on a regular basis compared to the younger group.Conclusions: The prevalence of polyps and their anatomical distribution was similar in African Americans aged 45-49 vs. those 50-59. Importantly, the presence of high grade dysplasia was more common in the younger group. Regular aspirin use in the older controls was perhaps protective for this group. Overall, our data would support the recommendation to screen African Americans age 45-49 for CRC.

M1529 Risk Factors of Adenoma Recurrence At Surveillance Colonoscopy: A Systematic Literature Review and Pooled Analysis Vincent De Jonge, Jerome Sint Nicolaas, Ernst J. Kuipers, Monique E. Van Leerdam, Sander Veldhuyzen Van Zanten IntroductionColorectal cancer screening guidelines recommend surveillance after adenoma removal. However, various guidelines vary considerable in advised surveillance intervals. This reflects the lack of comprehensive evidence of adenoma recurrence after baseline colonoscopy. This variation also affects adherence. Surveillance intervals need to be based on the risk of adenoma recurrence in the individual patient. We therefore aimed to assess the risk factors of adenoma recurrence.MethodsA systematic search was performed up to October 2008, using MedLine. Studies including baseline and follow-up colonoscopy, at least 6 months apart and with stratification for baseline findings, were included. Exclusion criteria were studies on high-risk patients and prevention trials with a significant effect. A Data Quality Score assessed study quality using inclusion criteria and data specification as main parameters. Pooled relative risks were calculated using random effects analysis.Results23 studies met the inclusion criteria (8 high quality (HQ), 15 non-HQ). A pooled RR for adenoma recurrence was calculated for presence of advanced adenomas (3 HQ, 2 non-HQ), adenomas ⱖ10 mm (5 HQ, 8 non-HQ), ⱖ3 adenomas (4 HQ, 11 non-HQ), villous adenomas (VA; 4 HQ, 6 non-HQ), high grade dysplasia (HGD; 2 HQ, 6 non-HQ), age ⱖ60 yrs (3 HQ, 3 non-HQ) and gender (6 HQ, 8 nonHQ).The results are shown in Table 1. Most important risk factors for adenoma recurrence were baseline presence of advanced adenomas (RR: 2.27), age ⱖ60 yrs (RR: 1.84), HGD (RR: 1.67) and ⱖ3 adenomas (RR: 1.60).ConclusionConvincing evidence exist that patients with advanced, ⱖ3 adenomas, HGD or age ⱖ60 yrs have an increased risk of adenoma recurrence. The evidence for other baseline findings for an increased risk of adenoma recurrence is inconclusive.Marked variation in study design and substantial heterogeneity between studies was observed and non-HQ studies reported lower RR’s, which emphasizes the necessity of well-performed and reported studies. Given the high impact of surveillance on patients and service providers, there is a marked need for further assessment of these parameters and subsequent development of targeted surveillance regimens.

Risk factor

HQ RR

HQ I2 Non-HQ Non-HQ I2 Overall RR Overall I2 (%) RR (%) (95% CI) (%)

Advanced adenomas 3.18 (ⱖ10 mm, HGD, VA) ⱖ10 mm 1.99

87

1.23*

75

40

1.48

79

ⱖ3 adenomas

2.20

86

1.44

17

VA

1.57

80

1.34*

72

HGD

2.15

49

1.43

39

AB246 GASTROINTESTINAL ENDOSCOPY

2.27 (1.094.75) 1.70 (1.322.18) 1.60 (1.321.94) 1.44 (1.121.87) 1.67 (1.242.24)

94 78 62 77 60

Volume 71, No. 5 : 2010

Risk factor

HQ RR

HQ I2 Non-HQ Non-HQ I2 Overall RR Overall I2 (%) RR (%) (95% CI) (%)

Age ⱖ60 yrs

2.21

0

1.47*

11

Male gender

1.30

0

1.16*

27

1.84 (1.342.54) 1.19 (1.071.32)

17 6

I2: % variability due to true difference; *: p⬎0.05

M1530 Early Precut Prevents Post-ERCP Pancreatitis: A Meta-Analysis of Randomized Controlled Trials Abhishek Choudhary, Nicholas M. Szary, Murtaza Arif, Hazem T. Hammad, Ghassan M. Hammoud, Matthew L. Bechtold, Jamal A. Ibdah Background: Deep biliary cannulation is important for performing therapeutic endoscopic biliary interventions. Precut technique is considered an independent risk factor for post-ERCP pancreatitis (PEP), along with multiple attempts at cannulation, guidewire cannulation, and pancreatic contrast injections. Multiple randomized controlled trails (RCTs) have been performed to compare the success and complication rates of the early precut procedure versus prolonged attempts with standard approach, but results are conflicting. Therefore, we conducted meta-analysis to compare the role of early precut technique versus prolonged approach for prevention of PEP and improving cannulation rates. Methods: MEDLINE, Cochrane Central Register of Controlled Trials & Database of Systematic Reviews, PubMed, and recent abstracts from major conference proceedings were searched (10/09). RCTs comparing early precut technique with prolonged conventional methods for cannulation rate and PEP were included. Standard forms were used to extract data by two independent reviewers. The effects of early precut technique were analyzed by calculating pooled estimates of PEP, cannulation rates, and complication rates. Separate analyses were performed for each outcome by using odds ratio (OR) or weighted mean difference (WMD) by fixed and random effects models. Publication bias was assessed by funnel plots. All studies were graded by Jadad score. Heterogeneity among studies was assessed by calculating I2 measure of inconsistency.Results: Four trials met inclusion criteria. Trials were of adequate quality (Jadad score ⱖ 2). No significant heterogeneity was noted for any of the outcomes. Precut timing in trials ranged from 5-12 minutes or after three accidental pancreatic duct cannulations. Total incidence of PEP was noted to be 2.12% in the early precut group in comparison to 8.69% in the conventional group. Early precut technique significantly decreases the odds for PEP (OR 0.24; 95% CI: 0.09-0.69, p⫽0.0008) in comparison to prolonged conventional methods. Additionally, precut technique significantly increases cannulation rate (OR 1.91; 95% CI: 1.07-3.39, p⫽0.03) without significantly increasing complication rates (OR 0.68; 95% CI: 0.37-1.26, p⫽0.23). No significant effect was observed for bleeding (OR 2.75; 95% CI: 0.74-10.30, p⫽0.13) and perforation (OR 1.55; 95% CI: 0.24-9.82, p⫽0.64). Funnel plot revealed no publication bias. Conclusions: The use of early precut technique for CBD cannulation decreases the odds of post-ERCP pancreatitis and improves the odds of successful cannulation.

M1531 Lower Gastrointestinal (GI) Bleeding - Initial Data From a Large Consortium of Endoscopy Practices Ian M. Gralnek, Glenn M. Eisen, Jennifer L. Holub Background: As compared to acute upper GI bleeding and outside of tertiary care centers, there are very limited data describing the population of patients presenting with acute lower GI bleeding (LGIB) undergoing endoscopy.Aims / Methods: The aim of this study was to describe the patient population presenting with LGIB in a large consortium of diverse gastroenterology practices in the United States using the Clinical Outcomes Research Initiative (CORI). The CORI database represents endoscopies for all types of indications and has been previously demonstrated to reflect what is observed in everyday gastroenterology clinical practice (76 practice sites in 26 US states). We identified all adult patients over a seven-year period, between 1/02 and 12/08, who underwent colonoscopy for the indication hematochezia. We characterized LGIB by patient demographics,disease co-morbidity, GI practice setting, endoscopic diagnosis, reported extent of colonoscopy examination, and adverse procedural events.Results: We identified n⫽76,928 persons who underwent colonoscopy for hematochezia. The majority were male n⫽43,907 (57%), White non-Hispanic n⫽62,949 (81.8%), and under the age of 60 years n⫽47,552 (61.8%). Most were evaluated at a community practice site n⫽60,290 (78.4%) and were defined as having a low risk ASA score (ASA Score ⫽ I or II) n⫽62,648 (81.4%). Endoscopic findings* included: hemorrhoids n⫽49,058 (63.8%), diverticulosis n⫽29,438 (38.3%), polyp n⫽25,205 (32.8%), mucosal abnormality / colitis n⫽5,985 (7.8%), multiple polyps n⫽4,356 (5.7%), tumor n⫽1,522 (2.0%), angiodysplasia n⫽899 (1.2%), solitary ulcer n⫽325 (0.4%). Only 94.8% of colonoscopy examinations reached the cecum and serious adverse events were rare.Conclusions: The

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