- Email: [email protected]
T1563 ScopeGuide® Reduces Pain During Colonoscopy
T1562
from the appropriate NHS Boards. To the end of September 2008, outcome data were available on 26 participants: 6 declined colonoscopy, 1 was judged unsuitable, 1 was already in follow-up, 2 did not attend, 7 had normal colonoscopy, 3 had low risk adenoma, 2 had a metaplastic polyp, 3 had diverticular disease, and 1 had a high risk adenoma. No participant had cancer. Conclusions: The analytical performance of the wipe test was satisfactory. However, a high percentage of participants were invited for colonoscopy. Moreover, a large number of participants spoiled the test and required a further set of tests. In addition, a high percentage referred declined colonoscopy and the pick up of significant neoplasia was small. The clinical performance characteristics of the wipe test are such that it cannot be recommended as a screening test for bowel cancer.
Health Related Quality of Life After Minimally Invasive Surgery for Diverticular Disease Marco Scarpa, Luciano Griggio, Cesare Ruffolo, Sabrina Rampado, Lara Borsetto, Marilisa Citton, Anna Pozza, Davide F. D'Amico, Imerio Angriman Background and aims Colonic resection is mandatory in complicated colonic diverticular disease (DD). The impact of video assisted surgery is still unclear. The aim of this study was to evaluate the clinical outcome and quality of life in patients affected by DD submitted to open colonic resection compared to those who had video assisted colonic resection. Patients and methods All the consecutive patients who were admitted in the departments of surgery of Padova (1999-2008) and Arzignano (2004-2008) Hospitals for left iliac pain and endoscopical or radiological diagnosis of diverticular disease, after a minimum follow up of 3 months after hospital discharge, were contacted for an outpatients visit. Fifty-eight accepted to be enrolled: 25 of them were treated with medical therapy while 18 and 15 of them underwent video assisted and open colonic resection, respectively. Disease severity at admission was assessed with Hinchey scale and details about surgical procedures and complications were retrieved. The interview included the Padova Inflammatory Bowel Disease Quality of Life (PIBDQL) and the Cleveland Global Quality of Life (CGQL) questionnaires, the Visual Analogue Scale (VAS) for quality of life, the Body Image Questionnaire, the Bristol Fecal score and an ad hoc symptoms score. Eighty-one healthy subjects were enrolled as control group. Non parametric tests were used. Results Either PIBDQL or CGQL scores were worse in all patients with DD compared to those obtained by healthy subjects (p<0.01). In fact, these scores were significantly worse in patients with DD treated with medical therapy and in those who had open surgery than in healthy subjects (p<0.01). On the contrary CGQL scores were similar in patients who had video assisted surgery compared to controls (Figure 1). PIBDQL scores correlated with the symptoms score (r=0.60, p<0.01). CGQL scores and VAS at follow up correlated with Hinchey disease activity at presentation (r=-0.31, p=0.02). Body Image Questionnaire scores correlated inversely with the presence of a stoma (r=-0.37, p=0.04). Conclusions Our study showed that DD has an important impact on quality of life. Video assisted surgery seems to improve generic quality of life of patients while disease specific quality of life seemed only to depend on current disease activity. The presence of a stoma affected the body image of patients.
T1565 Prediction of Lymph Node Metastases in Early Esophageal Cancer Ines Gockel, George Sgourakis, Mario Domeyer, Torsten Hansen, Theodor Junginger, Hauke Lang Introduction Whereas in mucosal carcinoma of the esophagus endoscopic local treatment is undisputably the recommended treatment, submucosal esophageal carcinoma reveals a higher percentage of lymph node metastases and consequently oncologic esophageal resection with systematic lymph node dissection is indicated. Increasingly, these carcinomas are treated by means of endoscopic submucosal dissection (ESD), although the diagnostic methods for the detection of potential lymph node metastases (endoscopic ultrasound, computed tomography and PET) are marked by an insufficient sensitivity and specifity. It was the aim of our study to produce a model for the prediction of lymph node metastases in early esophageal carcinoma. Methods We analyzed the clinical and histopathological data of 68 consecutive patients with a pT1-esophageal carcinoma in whom an oncological resection was performed in the Department of General and Abdominal Surgery, Mainz, Germany. Submucosal carcinomas (pT1b) were classified according to sm level I-III. In a first step we made a univariate analysis (one-way ANOVA) to test the predictive value of the following potential parameters with regard to the lymph node status (positive/negative): age, sex, histologic tumor type, tumor size, grading, mucosa-/submucosa-type, R-classification, pL, pV, localization of the tumor, and surgical technique (transhiatal / transthoracic approach). All significant variables of the univariate analysis were included in the multivariate analysis. For this purpose we used a general discrimination analysis (forward stepwise). In a third step, the Kruscal-Wallis test with post-hoc comparisons was applied to define the cut-off value of the parameter tested as significant which displays the risk category of a lymph node positivity. Results In the univariate analysis, tumor size (p=0.004), grading (p=0.034), pL (p=0.008), pV (p=0.05) and sm-type (p=0.035) proved to be statistically significant. The variables which attained significance in the multivariate analysis were tumor size (p=0.02) and pV (p= 0.034). In the Kruscal-Wallis test with post-hoc comparisons, the cut-off value of the tumor size was 1 cm (model p=0.014 and between the categories p=0.05). Conclusion The risk category of lymph node positivity in early esophageal cancer exists according to the prediction model on the basis of the tumor size of >1 cm and a venous infiltration. The hitherto usual sm-level I-III classification of submucosal carcinomas of the esophagus plays a minor role with regard to the prediction of potential lymph node metastases and consequently the indication for endoscopic or surgical therapy.
T1563
SSAT Abstracts
ScopeGuide® Reduces Pain During Colonoscopy Lars Enochsson, Rozh Noel, Michael Wedén, Urban Sjöqvist, Monica BomanGaliamoutsa, Urban Arnelo, Hans Törnblom Background: The ultimate goal of a successful colonoscopy is an accurate examination without causing discomfort or pain to the patient. ScopeGuide® (Olympus, Japan) is a product which displays the position and shape of the colonoscope and thereby is believed to shorten insertion time, facilitate loop elimination and increase patient comfort. This prospective study was designed to evaluate if ScopeGuide affected the outcome of colonoscopy. Methods: A total of 37 colonoscopies (23 women and 14 men; 53±2.4 years) were performed by four experienced endoscopists and three residents in gastroenterology. In 13 of the examinations biopsies were taken and excluded from the evaluation. ScopeGuide® was used in 14/24 colonoscopies. Patient discomfort, pain and general experience of the examinations were assessed using a VAS-scale. The technical difficulty and general experience of the examination were estimated by the endoscopists in a similar manner. Cecal intubation time was registered. Results: The patients where ScopeGuide was used experienced significantly less pain (4.3±0.8 vs. 6.7±0.6; P= 0.042). In the colonoscopies without ScopeGuide there was a positive correlation between the technical difficulty, as estimated by the doctor, and the pain experienced by the patients (R2=0,65; P=0.009). This correlation was abolished with ScopeGuide. There were no differences between the two groups regarding patient discomfort and general experience. The time to reach cecum in female patients was longer than in males (26±3.5 vs 10±2.6min). Conclusion: This prospective study demonstrates that using the additional help of ScopeGuide, which facilitates the elimination of loops, reduces the pain as experienced by patients during colonoscopy.
T1566 Comparison of the Conventional Manometry and High Resolution Manometry in the Assessment of the Resting Characteristics of the Lower Esophageal Sphincter: the Enemy of Good Is Better Shahin Ayazi, Jeffrey A. Hagen, Joerg Zehetner, Arzu Oezcelik, Emmanuele Abate, Calvin Wu, Oliver Ross, Paula Corsetti, Farzaneh Banki, John C. Lipham, Steven R. DeMeester, Tom R. DeMeester Introduction: High resolution manometry (HRM) has been widely accepted as an easier and more reproducible method to assess the esophageal body. Its usefulness in evaluating the lower esophageal sphincter (LES) has not been well studied. The goal of this study was to compare HRM to the standard pull-through technique in assessment of the resting characteristics of the LES. Methods: Conventional manometry (CM) using the station pullthrough technique and HRM with a solid state catheter were performed in 66 patients with foregut symptoms. HRM was performed in the supine position 30 minutes after CM. All patients had a videoesophagogram to identify the presence of a hiatal hernia. The LES was assessed in the spatiotemporal mode of HRM, with the boundaries of the LES defined as 1) distinct color change (blue to green) on the image based analysis, 2) using an isobaric contour of 2 mmHg and 3) a rise from gastric baseline in the diagram mode. In the tracing mode of HRM, the lower border of the LES was defined as in conventional manometry as a 2 mmHg rise above gastric baseline and the upper border as a drop below gastric baseline. The resting characteristics of the LES by HRM and CM were compared. Results: HRM consistently overestimated both overall and abdominal lengths of the LES and had poor correlation with the lengths measured by CM (table). The variability in LES length by HRM was greatest in patients with a hiatal hernia (1.8 vs. 0.9 cm, p=0.027). Bland-Altman analysis showed weak agreement between LES length determined by HRM and CM (95% limits of agreement -1.4 to 4.4 cm). CM identified 22 patients (33%) with a defective LES. Using the image based analysis of HRM, 7/22 patients (32%) with a defective valve on CM would be considered normal. The upper border of the LES varied up to 6 cm compared to CM. There was no significant difference in the resting pressure of the LES between CM and HRM (13.5 vs. 11.5 mmHg, p=0.15). Conclusion: HRM is less accurate in determining LES length with nearly one third of patients with a defective valve on CM considered normal. Discrepancies of more than 4 cm may occur, and are greatest in the presence of a hiatal hernia. There was significant variability in the location of the upper border of the LES which compromises accurate placement of a pH probe.
T1564 Experience with An Alternate Wipe Guaiac Fecal Occult Blood Test in a National Bowel Screening Program Paula McDonald, Linda Colford, Audrey Irvine, Margaret Kenicer, Robert J. Steele, Callum G. Fraser Background: The format of the traditional guaiac fecal occult blood test [gFOBT], particularly the collection technique, might lead to difficulties for some potential participants, particularly the visually impaired and those with poor manual dexterity. Methods: Four tests with different fecal collection approaches were investigated. Moreover, a focus group informed the decision to investigate further a wipe test. Randomly selected fecal samples [100] were tested with EZ-Wipe [three wipes for each] and hema-screen gFOBT [all six windows], both obtained from Immunostics Inc, Ocean, NJ 07712. This wipe test was then made available in the Scottish Bowel Screening Programme as from June 2007. SOPs were generated for the Centre staff to respond to requests for the wipe test. Results: Identical results were attained with both gFOBT techniques: the analytical detection limit found for the wipe test was 0.6 mg hemoglobin/g feces. To the end of August 2008, 334 requests were made for the wipe test. Overall, 433 wipe test packs were issued: this number includes replacement and follow-up packs. 236 wipe kit sets were analysed in the Centre Laboratory to the end of August 2008: 17 were positive, 118 negative, 71 weak positive, and 30 spoiled. Expressed as percentages, these are 7.2, 50.0, 30.1, and 12.7% respectively. The comparison, although not absolutely direct, is with gFOBT and the relevant percentages for this test were: 0.4, 90.7, 7.6 and 1.3%. With the wipe test, participants can be referred for colonoscopy either on first finding that all three wipes are positive or on finding that at least one of the three tests in each of two successfully completed wipe test sets are positive. The total number of participants referred through these routes was 33. The colonoscopy outcomes were requested
SSAT Abstracts
A-912
from the appropriate NHS Boards. To the end of September 2008, outcome data were available on 26 participants: 6 declined colonoscopy, 1 was judged unsuitable, 1 was already in follow-up, 2 did not attend, 7 had normal colonoscopy, 3 had low risk adenoma, 2 had a metaplastic polyp, 3 had diverticular disease, and 1 had a high risk adenoma. No participant had cancer. Conclusions: The analytical performance of the wipe test was satisfactory. However, a high percentage of participants were invited for colonoscopy. Moreover, a large number of participants spoiled the test and required a further set of tests. In addition, a high percentage referred declined colonoscopy and the pick up of significant neoplasia was small. The clinical performance characteristics of the wipe test are such that it cannot be recommended as a screening test for bowel cancer.
Health Related Quality of Life After Minimally Invasive Surgery for Diverticular Disease Marco Scarpa, Luciano Griggio, Cesare Ruffolo, Sabrina Rampado, Lara Borsetto, Marilisa Citton, Anna Pozza, Davide F. D'Amico, Imerio Angriman Background and aims Colonic resection is mandatory in complicated colonic diverticular disease (DD). The impact of video assisted surgery is still unclear. The aim of this study was to evaluate the clinical outcome and quality of life in patients affected by DD submitted to open colonic resection compared to those who had video assisted colonic resection. Patients and methods All the consecutive patients who were admitted in the departments of surgery of Padova (1999-2008) and Arzignano (2004-2008) Hospitals for left iliac pain and endoscopical or radiological diagnosis of diverticular disease, after a minimum follow up of 3 months after hospital discharge, were contacted for an outpatients visit. Fifty-eight accepted to be enrolled: 25 of them were treated with medical therapy while 18 and 15 of them underwent video assisted and open colonic resection, respectively. Disease severity at admission was assessed with Hinchey scale and details about surgical procedures and complications were retrieved. The interview included the Padova Inflammatory Bowel Disease Quality of Life (PIBDQL) and the Cleveland Global Quality of Life (CGQL) questionnaires, the Visual Analogue Scale (VAS) for quality of life, the Body Image Questionnaire, the Bristol Fecal score and an ad hoc symptoms score. Eighty-one healthy subjects were enrolled as control group. Non parametric tests were used. Results Either PIBDQL or CGQL scores were worse in all patients with DD compared to those obtained by healthy subjects (p<0.01). In fact, these scores were significantly worse in patients with DD treated with medical therapy and in those who had open surgery than in healthy subjects (p<0.01). On the contrary CGQL scores were similar in patients who had video assisted surgery compared to controls (Figure 1). PIBDQL scores correlated with the symptoms score (r=0.60, p<0.01). CGQL scores and VAS at follow up correlated with Hinchey disease activity at presentation (r=-0.31, p=0.02). Body Image Questionnaire scores correlated inversely with the presence of a stoma (r=-0.37, p=0.04). Conclusions Our study showed that DD has an important impact on quality of life. Video assisted surgery seems to improve generic quality of life of patients while disease specific quality of life seemed only to depend on current disease activity. The presence of a stoma affected the body image of patients.
T1565 Prediction of Lymph Node Metastases in Early Esophageal Cancer Ines Gockel, George Sgourakis, Mario Domeyer, Torsten Hansen, Theodor Junginger, Hauke Lang Introduction Whereas in mucosal carcinoma of the esophagus endoscopic local treatment is undisputably the recommended treatment, submucosal esophageal carcinoma reveals a higher percentage of lymph node metastases and consequently oncologic esophageal resection with systematic lymph node dissection is indicated. Increasingly, these carcinomas are treated by means of endoscopic submucosal dissection (ESD), although the diagnostic methods for the detection of potential lymph node metastases (endoscopic ultrasound, computed tomography and PET) are marked by an insufficient sensitivity and specifity. It was the aim of our study to produce a model for the prediction of lymph node metastases in early esophageal carcinoma. Methods We analyzed the clinical and histopathological data of 68 consecutive patients with a pT1-esophageal carcinoma in whom an oncological resection was performed in the Department of General and Abdominal Surgery, Mainz, Germany. Submucosal carcinomas (pT1b) were classified according to sm level I-III. In a first step we made a univariate analysis (one-way ANOVA) to test the predictive value of the following potential parameters with regard to the lymph node status (positive/negative): age, sex, histologic tumor type, tumor size, grading, mucosa-/submucosa-type, R-classification, pL, pV, localization of the tumor, and surgical technique (transhiatal / transthoracic approach). All significant variables of the univariate analysis were included in the multivariate analysis. For this purpose we used a general discrimination analysis (forward stepwise). In a third step, the Kruscal-Wallis test with post-hoc comparisons was applied to define the cut-off value of the parameter tested as significant which displays the risk category of a lymph node positivity. Results In the univariate analysis, tumor size (p=0.004), grading (p=0.034), pL (p=0.008), pV (p=0.05) and sm-type (p=0.035) proved to be statistically significant. The variables which attained significance in the multivariate analysis were tumor size (p=0.02) and pV (p= 0.034). In the Kruscal-Wallis test with post-hoc comparisons, the cut-off value of the tumor size was 1 cm (model p=0.014 and between the categories p=0.05). Conclusion The risk category of lymph node positivity in early esophageal cancer exists according to the prediction model on the basis of the tumor size of >1 cm and a venous infiltration. The hitherto usual sm-level I-III classification of submucosal carcinomas of the esophagus plays a minor role with regard to the prediction of potential lymph node metastases and consequently the indication for endoscopic or surgical therapy.
T1563
SSAT Abstracts
ScopeGuide® Reduces Pain During Colonoscopy Lars Enochsson, Rozh Noel, Michael Wedén, Urban Sjöqvist, Monica BomanGaliamoutsa, Urban Arnelo, Hans Törnblom Background: The ultimate goal of a successful colonoscopy is an accurate examination without causing discomfort or pain to the patient. ScopeGuide® (Olympus, Japan) is a product which displays the position and shape of the colonoscope and thereby is believed to shorten insertion time, facilitate loop elimination and increase patient comfort. This prospective study was designed to evaluate if ScopeGuide affected the outcome of colonoscopy. Methods: A total of 37 colonoscopies (23 women and 14 men; 53±2.4 years) were performed by four experienced endoscopists and three residents in gastroenterology. In 13 of the examinations biopsies were taken and excluded from the evaluation. ScopeGuide® was used in 14/24 colonoscopies. Patient discomfort, pain and general experience of the examinations were assessed using a VAS-scale. The technical difficulty and general experience of the examination were estimated by the endoscopists in a similar manner. Cecal intubation time was registered. Results: The patients where ScopeGuide was used experienced significantly less pain (4.3±0.8 vs. 6.7±0.6; P= 0.042). In the colonoscopies without ScopeGuide there was a positive correlation between the technical difficulty, as estimated by the doctor, and the pain experienced by the patients (R2=0,65; P=0.009). This correlation was abolished with ScopeGuide. There were no differences between the two groups regarding patient discomfort and general experience. The time to reach cecum in female patients was longer than in males (26±3.5 vs 10±2.6min). Conclusion: This prospective study demonstrates that using the additional help of ScopeGuide, which facilitates the elimination of loops, reduces the pain as experienced by patients during colonoscopy.
T1566 Comparison of the Conventional Manometry and High Resolution Manometry in the Assessment of the Resting Characteristics of the Lower Esophageal Sphincter: the Enemy of Good Is Better Shahin Ayazi, Jeffrey A. Hagen, Joerg Zehetner, Arzu Oezcelik, Emmanuele Abate, Calvin Wu, Oliver Ross, Paula Corsetti, Farzaneh Banki, John C. Lipham, Steven R. DeMeester, Tom R. DeMeester Introduction: High resolution manometry (HRM) has been widely accepted as an easier and more reproducible method to assess the esophageal body. Its usefulness in evaluating the lower esophageal sphincter (LES) has not been well studied. The goal of this study was to compare HRM to the standard pull-through technique in assessment of the resting characteristics of the LES. Methods: Conventional manometry (CM) using the station pullthrough technique and HRM with a solid state catheter were performed in 66 patients with foregut symptoms. HRM was performed in the supine position 30 minutes after CM. All patients had a videoesophagogram to identify the presence of a hiatal hernia. The LES was assessed in the spatiotemporal mode of HRM, with the boundaries of the LES defined as 1) distinct color change (blue to green) on the image based analysis, 2) using an isobaric contour of 2 mmHg and 3) a rise from gastric baseline in the diagram mode. In the tracing mode of HRM, the lower border of the LES was defined as in conventional manometry as a 2 mmHg rise above gastric baseline and the upper border as a drop below gastric baseline. The resting characteristics of the LES by HRM and CM were compared. Results: HRM consistently overestimated both overall and abdominal lengths of the LES and had poor correlation with the lengths measured by CM (table). The variability in LES length by HRM was greatest in patients with a hiatal hernia (1.8 vs. 0.9 cm, p=0.027). Bland-Altman analysis showed weak agreement between LES length determined by HRM and CM (95% limits of agreement -1.4 to 4.4 cm). CM identified 22 patients (33%) with a defective LES. Using the image based analysis of HRM, 7/22 patients (32%) with a defective valve on CM would be considered normal. The upper border of the LES varied up to 6 cm compared to CM. There was no significant difference in the resting pressure of the LES between CM and HRM (13.5 vs. 11.5 mmHg, p=0.15). Conclusion: HRM is less accurate in determining LES length with nearly one third of patients with a defective valve on CM considered normal. Discrepancies of more than 4 cm may occur, and are greatest in the presence of a hiatal hernia. There was significant variability in the location of the upper border of the LES which compromises accurate placement of a pH probe.
T1564 Experience with An Alternate Wipe Guaiac Fecal Occult Blood Test in a National Bowel Screening Program Paula McDonald, Linda Colford, Audrey Irvine, Margaret Kenicer, Robert J. Steele, Callum G. Fraser Background: The format of the traditional guaiac fecal occult blood test [gFOBT], particularly the collection technique, might lead to difficulties for some potential participants, particularly the visually impaired and those with poor manual dexterity. Methods: Four tests with different fecal collection approaches were investigated. Moreover, a focus group informed the decision to investigate further a wipe test. Randomly selected fecal samples [100] were tested with EZ-Wipe [three wipes for each] and hema-screen gFOBT [all six windows], both obtained from Immunostics Inc, Ocean, NJ 07712. This wipe test was then made available in the Scottish Bowel Screening Programme as from June 2007. SOPs were generated for the Centre staff to respond to requests for the wipe test. Results: Identical results were attained with both gFOBT techniques: the analytical detection limit found for the wipe test was 0.6 mg hemoglobin/g feces. To the end of August 2008, 334 requests were made for the wipe test. Overall, 433 wipe test packs were issued: this number includes replacement and follow-up packs. 236 wipe kit sets were analysed in the Centre Laboratory to the end of August 2008: 17 were positive, 118 negative, 71 weak positive, and 30 spoiled. Expressed as percentages, these are 7.2, 50.0, 30.1, and 12.7% respectively. The comparison, although not absolutely direct, is with gFOBT and the relevant percentages for this test were: 0.4, 90.7, 7.6 and 1.3%. With the wipe test, participants can be referred for colonoscopy either on first finding that all three wipes are positive or on finding that at least one of the three tests in each of two successfully completed wipe test sets are positive. The total number of participants referred through these routes was 33. The colonoscopy outcomes were requested
SSAT Abstracts
A-912