- Email: [email protected]
Sa1616 Risk Factors Associated With Multiple and Missed Gastric Neoplastic Lesions After Endoscopic Resection; Prospective Study At a Single Institution in South Korea (When Do We Perform Follow up Endoscopy After Endoscopic Resection of Gastric Neoplastic Lesion?)
Abstracts
gastric cancer patients was high but active infection was low. Most of gastric cancer patients presented in advance stage and had grave prognosis. There was no significant difference of clinical information, endoscopic findings and histological type of gastric cancer between active and non-active H. pylori infection in Thailand.
rate of bleeding was similar when reading in quickview compared with automatic view. Automatic quadview 20fps has minimal diagnostic miss rates and can safely replace slower modes in clinical practice. A theoretical advantage of quadview is a longer single frame exposure time compared with singleview. Conclusions: Quickview can be used confidently in small bowel bleeding and can be performed in a short time. However, quickview mode has a high false negative rate for the other lesions, such as ulcers or erosions. Selection among time-saving methods should be made on the basis of the clinical indication for the capsule endoscopy.
Sa1616 Risk Factors Associated With Multiple and Missed Gastric Neoplastic Lesions After Endoscopic Resection; Prospective Study At a Single Institution in South Korea (When Do We Perform Follow up Endoscopy After Endoscopic Resection of Gastric Neoplastic Lesion?) Seok Reyol Choi*, Jin Seok Jang Dong- A university, Busan, Republic of Korea Introduction: Because only a small part of the gastric mucosa containing the visible lesion can be removed by endoscopic resection, accurate detection of multiple lesions is important. This study was aimed to identify the incidence rate and associated risk factors of multiple and missed gastric lesions, and proper timing of follow up endoscopy within one year after endoscopic resection. Methods: The patients, who had gastric neoplastic lesion and scheduled to undergo endoscopic resection, were prospectively enrolled. Intensively endoscopic surveillance was performed on 1 week, and 1, 6, 12 months after endoscopic resection. All multiple gastric lesions were divided into main and accessory lesion, and accessory lesions were subdivided into detected and missed lesion. Results: A total 250 lesions of 215 patients were analyzed, and there were 81 of early gastric cancer, 50 of high grade dysplasias and 119 of low grade dysplasias. The overall incidence rate of synchronous gastric cancer was 5.3%. And a total 30(14%) of 215 patients had multiple gastric neoplastic lesions, either adenoma or cancer, within 1 year follow up after endoscopic resection. In univariate and multivariate analysis, old age (odds ratio 1.063, 95% CI 1.0091.121), men (odds ratio 3.412, 95% CI 0.095-0.907) and severe intestinal metaplasia (odds ratio 3.268, 95% CI 0.129-0.728) were independent risk factors of multiple gastric lesions. Of 35 accessory lesions in 30 patients, 25 lesions in 21 patients (25/35, 71.4%) were detected at preoperative endoscopic examination, and 10 accessory lesions in 9 patients were missed (10/35, 28.6%). Small size (ⱕ1cm) and flat morphology were major risk factors for missed lesion by endoscopy (p⫽0.047, p⫽0.027). Among 10 missed lesions, 9 (90%) lesions could be detected within 6 month after endoscopic resection. Conclusion: We should keep in mind the fact that old age, men and severe intestinal metaplasia were risk factors for multiple gastric lesions after endoscopic resection, and multiple gastric lesions can often be missed at the time of treatment. Therefore, to reduce a missing of multiple gastric lesions, the entire stomach should be carefully examined, and follow up endoscopy might be necessary at least one time within six month after endoscopic resection.
Sa1618 Can Inexperienced Trainees Reliably Detect Relevant Clinical Findings on Capsule Endoscopy and Which Mode and Speed Should They Use? a Randomized Trial Alexander J. Eckardt*1, Alexandra Bergk2, Eleftheria Giannakoulopoulou2, Johannes Meier2, Gomes M. Eleonora2, Sebastian Geiger2, Jan Krahn1, Andreas Adler2 1 Gastroenterology and Hepatology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany; 2Central Interdisciplinary Endoscopy, Charité Campus Virchow, Berlin, Germany Introduction: Reading small bowel (SB) capsule endoscopy is time consuming. Prereading by trainees might allow experienced readers to focus on relevant findings and save time. However, it remains unclear whether inexperienced trainees will detect relevant findings and which mode and speed should be used. Aims&Methods: The aim was to assess the trainees’ yield of detecting major findings in the SB. The same 45 capsules were read by 2 experienced gastroenterologists (controls) 4-view/15 frames/s (fps). Thumbnails of relevant findings were obtained. In cases of discrepancy, consensus was reached with a third experienced reader. Five trainees (ⱖ5 practice capsules) read the same 45 capsules in 9 mode/speed combinations (1-, 2- and 4-view and 5, 10, 15 fps) which were randomly assigned. The focus was on SB images. Stomach and colon were only briefly screened. Results: Major findings (e.g. bleeding, ulcers, angiodysplasias, tumors) were present in 33% (15/45) of cases. 3 were located in the stomach or colon. The yields are outlined in the Table. One bleed was missed by 4/5 trainees and 1 control (seen only on a few frames). Eight of 9 missed lesions were viewed in 2 or 4-view mode. One trainee missed a lesion in single-view, but it was also missed by a control. Six of 9 missed lesions were viewed at 10 or 15 fps. Conclusion: The yield of identifying relevant findings by trainees approximates that of experienced physicians, using speeds of up to 15fps. Single view might initially be preferable for trainees. Because lesions can be missed by trainees and staff in- and outside the SB, quality control is prudent. Diagnostic Yield of Trainees and Controls Table
Sa1617 What Is the Most Efficient and Time Saving Capsule Endoscopy Reading Mode? Yoon Tae Jeen*1, Ye Ji Kim1, Sun Young Kim1, Minho Seo1, Woo Jin Lee1, Hyuk Soon Choi1, Eun Sun Kim1, Bora Keum1, Hong Sik Lee1, Hoon Jai Chun1, Soon Ho Um1, Chang Duck Kim1, Ho Sang Ryu1, Nark-Soon Park1, Sung Chul Park2 1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, Republic of Korea; 2Department of Internal medicine, Kangwon National University School of Medicine, Kangwon, Republic of Korea Backgrond/Aims: Capsule endoscopy is a useful test for evaluation of the small bowel. However, capsule endoscopy is needed the substantial time for capsule reading. Although many attempts have been made to reduce the reading time, there was no definite conclusion about the best reading mode to save the time and have a diagnostic accuracy. The aim of this study was to investigate evaluation times and false negative rates in three different reading modes to find the most appropriate mode for evaluation of capsule endoscopy. Methods: Three trainee endoscopists reviewed capsule endoscopy studies performed at our institution from 5/2007 to 6/2012. Each trainee endoscopist read a total of 30 capsule endoscopy videos. Three endoscopists compared three different capsule endoscopic software modes: automatic view at a speed of 20 frames per second (fps) and automatic quadview at a speed of 20 fps, quickview at a speed of 4 fps. Each endoscopist read the same capsule endoscopic record by using one of three different software modes. Capsule endoscopic reading time was recorded, and the number of detected lesions was counted. Results: The mean evaluation time using quickview was significantly shorter than with automatic view (automatic single view: 18 min 48 sec, quadview: 19 min, quickview: 2 min 7 sec). The false negative rates of ulcers, erosions were higher when reading in quickview compared with reading in automatic view. However, the detection
www.giejournal.org
Identification of significant SB Lesions Identification of lesions outside the SB Overall yield
Trainee 1
Trainee 2
Trainee 3
Trainee 4
Trainee 5
Control 1
Control 2
92% (11/12)
75% (9/12)
92% (11/12)
75% (9/12)
92% (11/12)
83% (10/12)
100% (12/12)
67% (2/3)
33% (1/3)
0% (0/3)
33% (1/3)
100% (3/3)
100% (3/3)
67% (2/3)
87% (13/15)
67% (10/15)
73% (11/15)
67% (10/15)
93% (14/15)
87% (13/15)
93% (14/15)
Sa1619 Efficacy of Flexible Spectral Imaging Color Enhancement (FICE) in Patients Without Any Findings by Conventional Capsule Endoscopy Yuka Kobayashi*, Atsuo Yamada, Hirotsugu Watabe, Hirobumi Suzuki, Yoshihiro Hirata, Yutaka Yamaji, Haruhiko Yoshida, Kazuhiko Koike Gastroenterology, University of Tokyo, Tokyo, Japan Introduction: Flexible spectral imaging color enhancement (FICE) has been included in capsule endoscopy (CE) reading system, Rapid 6.5 (Given Imaging, Yoqneam, Israel). We reported efficacy of FICE ch.1 (F1, wavelength red 595, green 540, blue 535nm) for detection on ulcerative lesions and angioectasias in the small intestine at CE. In the present study, we aimed to elucidate whether F1 detects on incremental findings in patients without any findings by standard review mode. Method: A total of 52 patients with obscure gastrointestinal bleeding (OGIB) (Age 60.1⫾15.3 years, 30 males, 27 overt OGIB and 25 occult OGIB) who received CE and no lesion was detected in the small intestine at standard mode (1st review) were enrolled into the present study. Pillcam SB or SB2 (Given Imaging, Israel) was used for CE examination. Preparation was fasting for 12 hours and administration of simethicone just before CE. Two experienced endoscopists independently reviewed CE videos again by F1 (2nd
Volume 77, No. 5S : 2013
GASTROINTESTINAL ENDOSCOPY
AB269
gastric cancer patients was high but active infection was low. Most of gastric cancer patients presented in advance stage and had grave prognosis. There was no significant difference of clinical information, endoscopic findings and histological type of gastric cancer between active and non-active H. pylori infection in Thailand.
rate of bleeding was similar when reading in quickview compared with automatic view. Automatic quadview 20fps has minimal diagnostic miss rates and can safely replace slower modes in clinical practice. A theoretical advantage of quadview is a longer single frame exposure time compared with singleview. Conclusions: Quickview can be used confidently in small bowel bleeding and can be performed in a short time. However, quickview mode has a high false negative rate for the other lesions, such as ulcers or erosions. Selection among time-saving methods should be made on the basis of the clinical indication for the capsule endoscopy.
Sa1616 Risk Factors Associated With Multiple and Missed Gastric Neoplastic Lesions After Endoscopic Resection; Prospective Study At a Single Institution in South Korea (When Do We Perform Follow up Endoscopy After Endoscopic Resection of Gastric Neoplastic Lesion?) Seok Reyol Choi*, Jin Seok Jang Dong- A university, Busan, Republic of Korea Introduction: Because only a small part of the gastric mucosa containing the visible lesion can be removed by endoscopic resection, accurate detection of multiple lesions is important. This study was aimed to identify the incidence rate and associated risk factors of multiple and missed gastric lesions, and proper timing of follow up endoscopy within one year after endoscopic resection. Methods: The patients, who had gastric neoplastic lesion and scheduled to undergo endoscopic resection, were prospectively enrolled. Intensively endoscopic surveillance was performed on 1 week, and 1, 6, 12 months after endoscopic resection. All multiple gastric lesions were divided into main and accessory lesion, and accessory lesions were subdivided into detected and missed lesion. Results: A total 250 lesions of 215 patients were analyzed, and there were 81 of early gastric cancer, 50 of high grade dysplasias and 119 of low grade dysplasias. The overall incidence rate of synchronous gastric cancer was 5.3%. And a total 30(14%) of 215 patients had multiple gastric neoplastic lesions, either adenoma or cancer, within 1 year follow up after endoscopic resection. In univariate and multivariate analysis, old age (odds ratio 1.063, 95% CI 1.0091.121), men (odds ratio 3.412, 95% CI 0.095-0.907) and severe intestinal metaplasia (odds ratio 3.268, 95% CI 0.129-0.728) were independent risk factors of multiple gastric lesions. Of 35 accessory lesions in 30 patients, 25 lesions in 21 patients (25/35, 71.4%) were detected at preoperative endoscopic examination, and 10 accessory lesions in 9 patients were missed (10/35, 28.6%). Small size (ⱕ1cm) and flat morphology were major risk factors for missed lesion by endoscopy (p⫽0.047, p⫽0.027). Among 10 missed lesions, 9 (90%) lesions could be detected within 6 month after endoscopic resection. Conclusion: We should keep in mind the fact that old age, men and severe intestinal metaplasia were risk factors for multiple gastric lesions after endoscopic resection, and multiple gastric lesions can often be missed at the time of treatment. Therefore, to reduce a missing of multiple gastric lesions, the entire stomach should be carefully examined, and follow up endoscopy might be necessary at least one time within six month after endoscopic resection.
Sa1618 Can Inexperienced Trainees Reliably Detect Relevant Clinical Findings on Capsule Endoscopy and Which Mode and Speed Should They Use? a Randomized Trial Alexander J. Eckardt*1, Alexandra Bergk2, Eleftheria Giannakoulopoulou2, Johannes Meier2, Gomes M. Eleonora2, Sebastian Geiger2, Jan Krahn1, Andreas Adler2 1 Gastroenterology and Hepatology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany; 2Central Interdisciplinary Endoscopy, Charité Campus Virchow, Berlin, Germany Introduction: Reading small bowel (SB) capsule endoscopy is time consuming. Prereading by trainees might allow experienced readers to focus on relevant findings and save time. However, it remains unclear whether inexperienced trainees will detect relevant findings and which mode and speed should be used. Aims&Methods: The aim was to assess the trainees’ yield of detecting major findings in the SB. The same 45 capsules were read by 2 experienced gastroenterologists (controls) 4-view/15 frames/s (fps). Thumbnails of relevant findings were obtained. In cases of discrepancy, consensus was reached with a third experienced reader. Five trainees (ⱖ5 practice capsules) read the same 45 capsules in 9 mode/speed combinations (1-, 2- and 4-view and 5, 10, 15 fps) which were randomly assigned. The focus was on SB images. Stomach and colon were only briefly screened. Results: Major findings (e.g. bleeding, ulcers, angiodysplasias, tumors) were present in 33% (15/45) of cases. 3 were located in the stomach or colon. The yields are outlined in the Table. One bleed was missed by 4/5 trainees and 1 control (seen only on a few frames). Eight of 9 missed lesions were viewed in 2 or 4-view mode. One trainee missed a lesion in single-view, but it was also missed by a control. Six of 9 missed lesions were viewed at 10 or 15 fps. Conclusion: The yield of identifying relevant findings by trainees approximates that of experienced physicians, using speeds of up to 15fps. Single view might initially be preferable for trainees. Because lesions can be missed by trainees and staff in- and outside the SB, quality control is prudent. Diagnostic Yield of Trainees and Controls Table
Sa1617 What Is the Most Efficient and Time Saving Capsule Endoscopy Reading Mode? Yoon Tae Jeen*1, Ye Ji Kim1, Sun Young Kim1, Minho Seo1, Woo Jin Lee1, Hyuk Soon Choi1, Eun Sun Kim1, Bora Keum1, Hong Sik Lee1, Hoon Jai Chun1, Soon Ho Um1, Chang Duck Kim1, Ho Sang Ryu1, Nark-Soon Park1, Sung Chul Park2 1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, Republic of Korea; 2Department of Internal medicine, Kangwon National University School of Medicine, Kangwon, Republic of Korea Backgrond/Aims: Capsule endoscopy is a useful test for evaluation of the small bowel. However, capsule endoscopy is needed the substantial time for capsule reading. Although many attempts have been made to reduce the reading time, there was no definite conclusion about the best reading mode to save the time and have a diagnostic accuracy. The aim of this study was to investigate evaluation times and false negative rates in three different reading modes to find the most appropriate mode for evaluation of capsule endoscopy. Methods: Three trainee endoscopists reviewed capsule endoscopy studies performed at our institution from 5/2007 to 6/2012. Each trainee endoscopist read a total of 30 capsule endoscopy videos. Three endoscopists compared three different capsule endoscopic software modes: automatic view at a speed of 20 frames per second (fps) and automatic quadview at a speed of 20 fps, quickview at a speed of 4 fps. Each endoscopist read the same capsule endoscopic record by using one of three different software modes. Capsule endoscopic reading time was recorded, and the number of detected lesions was counted. Results: The mean evaluation time using quickview was significantly shorter than with automatic view (automatic single view: 18 min 48 sec, quadview: 19 min, quickview: 2 min 7 sec). The false negative rates of ulcers, erosions were higher when reading in quickview compared with reading in automatic view. However, the detection
www.giejournal.org
Identification of significant SB Lesions Identification of lesions outside the SB Overall yield
Trainee 1
Trainee 2
Trainee 3
Trainee 4
Trainee 5
Control 1
Control 2
92% (11/12)
75% (9/12)
92% (11/12)
75% (9/12)
92% (11/12)
83% (10/12)
100% (12/12)
67% (2/3)
33% (1/3)
0% (0/3)
33% (1/3)
100% (3/3)
100% (3/3)
67% (2/3)
87% (13/15)
67% (10/15)
73% (11/15)
67% (10/15)
93% (14/15)
87% (13/15)
93% (14/15)
Sa1619 Efficacy of Flexible Spectral Imaging Color Enhancement (FICE) in Patients Without Any Findings by Conventional Capsule Endoscopy Yuka Kobayashi*, Atsuo Yamada, Hirotsugu Watabe, Hirobumi Suzuki, Yoshihiro Hirata, Yutaka Yamaji, Haruhiko Yoshida, Kazuhiko Koike Gastroenterology, University of Tokyo, Tokyo, Japan Introduction: Flexible spectral imaging color enhancement (FICE) has been included in capsule endoscopy (CE) reading system, Rapid 6.5 (Given Imaging, Yoqneam, Israel). We reported efficacy of FICE ch.1 (F1, wavelength red 595, green 540, blue 535nm) for detection on ulcerative lesions and angioectasias in the small intestine at CE. In the present study, we aimed to elucidate whether F1 detects on incremental findings in patients without any findings by standard review mode. Method: A total of 52 patients with obscure gastrointestinal bleeding (OGIB) (Age 60.1⫾15.3 years, 30 males, 27 overt OGIB and 25 occult OGIB) who received CE and no lesion was detected in the small intestine at standard mode (1st review) were enrolled into the present study. Pillcam SB or SB2 (Given Imaging, Israel) was used for CE examination. Preparation was fasting for 12 hours and administration of simethicone just before CE. Two experienced endoscopists independently reviewed CE videos again by F1 (2nd
Volume 77, No. 5S : 2013
GASTROINTESTINAL ENDOSCOPY
AB269