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⁎4483 Argon plasma coagulation is an effective and well tolerated treatment for rectal bleeding due to chronic radiation proctitis.
*4482 USEFULNESS OF POLYMERASE CHAIN REACTION FOR THE DIFFERENTIAL DIAGNOSIS OF INTESTINAL TUBERCULOSIS AND CROHN’S DISEASE. Kwang Ro Joo, Suk-Kyun Yang, Seung Jae Myung, Gyeong Hoon Kang, Jae Won Choe, Eui-Ryun Park, Ki Nam Shim, Do Ha Kim, Hwoon-Yong Jung, Weon-Seon Hong, Young Il Min, Univ of Ulsan Coll of Medicine, Asan Med Ctr, Seoul, South Korea. Background & Aim: The definite diagnosis of intestinal tuberculosis (I-TB) is made by histological evidence of caseating granulomas or acid-fast bacilli, or growth of M. tuberculosis on culture of biopsy specimens. It is often difficult, however, to differentiate I-TB from Crohn’s disease (CD) when all of the three tests were negative. The aim of this study was to evaluate the usefulness of M. tuberculosis complex-polymerase chain reaction (TBCPCR) for the differential diagnosis of I-TB and CD. Methods: We obtained biopsy specimens from 32 patients with I-TB and 29 patients with CD. Ziehl-Neelsen stain, M. tuberculosis culture and TBC-PCR were carried out in all patients. TBC-PCR was also performed with normal colonic specimens obtained from 22 patients with colonic polyps as the control. TBCPCR was done with DNA extracted from the paraffin-embedded tissues in all cases. Four pairs of oligonucleotide primers (Bioneer, Korea) were used for the nested PCR at the two different sites of IS6110 insertion element of M. tuberculosis complex. Results: The TBC-PCR gave positive results in 23 (72%) of 32 patients with I-TB, 3 (10%) of 29 patients with CD, and 3 (14%) of 22 normal controls, yielding a sensitivity of the TBC-PCR on biopsy specimens of 72% and a specificity of 88%. In patients with I-TB, the sensitivity of culture, acid-fast bacilli stain and caseating granulomas were 44%, 25% and 9%, respectively. When all of these three tests were combined, the sensitivity rose to 63%. In addition, among the 12 I-TB patients with the negative result in all of the three conventional tests, 8 (67%) were PCR-positive. Therefore when the result of TBC-PCR was combined with that of histological examination and culture, the sensitivity became higher upto 88%. The positive rate of TBC-PCR was 100% in patients showing caseating granulomas or acid-fast bacilli on histological examination, and 64% in culture-positive patients. Conclusions: TBC-PCR is a very sensitive method for the diagnosis of I-TB. Therefore, combining of TBC-PCR with conventional methods might be helpful in differentiating I-TB from CD.
*4484 COLONOSCOPIC FINDINGS IN INTESTINAL BEHCET’S DISEASE. Won Ho Kim, Chung Ryul Lee, Yong Suk Cho, Jeong Youp Park, Myung Whan Kim, In Suh Park, Yonsei Univ Coll of Medicine, Seoul, South Korea. Background: Behcet’s disease is a multisystemic chronic inflammatory disease characterized by oral ulcer, genital ulcer, skin manifestations and ocular involvements as major symptoms. Minor symtoms include arthritis or arthralgia, vascular lesion, CNS involvement, epididymitis, and intestinal ulcers. Intestinal involvement in Behcet’s disease is not rare in Korea. Ulceration can occur in any part of the gastrointestinal tract including the esophagus, stomach and duodenum, but the ileo-cecal area is the most commonly involved site. Aim: The aim of this study was to characterize the colonoscopic findings of intestinal Behcet’s disease. Methods: We retrospectively reviewed colonoscopic examinations in 92 patients with intestinal Behcet’s disease. Among 92 patients, complete, incomplete, suspicious, and possible types included 16, 26, 24, and 18 cases, respectively. The remaining 8 cases did not have any major systemic manifestation of Behcet’s disease. About 2/3 of the patients were diagnosed as Behcet’s disease before intestinal involvement was identified. Twenty-four (26%) patients had a previous history of intestinal resection at the time of colonoscopy. Results: Abdominal pain (94%) was the most common symptom, followed by diarrhea (30%), melena/hematochezia (25%), weight loss, fever, indigestion and nausea/ vomiting. Colonoscopy demonstrated ulcerative lesions in all cases. Among patients who did not have operations, ileo-cecal area was the most commonly involved site (92%). Seven (8%) patients had ulcers in other parts of the colon. All of the operated patients had ulcers at the ileo-colonic anastomostic site. Most (95%) of the ulcers were round/oval or geographic in shape while longitudinal or circumferential ulcers were rare (5%). Sixty-one patients (66%) had a single ulcer, 19 (21%) had several (2-5) ulcers, and 12 (13%) had multiple (≥6) ulcers. The ulcer was small (≤ 10 mm) in 20 patients (22%), medium-sized (11-20 mm) in 20 (22%), and large (> 20 mm) in 52 patients (57%). Mean size of ulcer was 3.0 cm. The ulcer was deep in 56 patients (61%) while shallow in 36 (39%). The margin of ulcer was discrete in 75 cases (82%), elevated and nodular in 56 cases (62%), and erythematous in 48 cases (52%). Mucosal changes adjacent to the ulceration such as erhthema and edema were not common, and were noted in 22 cases (24%). Conclusion: Typical colonoscopic finding in intestinal Behcet’s disease included a single or a few deep ulcers with discrete margin and normal adjacent mucosa in the ileocecal area or ileo-colonic anastomotic site.
*4483 ARGON PLASMA COAGULATION IS AN EFFECTIVE AND WELL TOLERATED TREATMENT FOR RECTAL BLEEDING DUE TO CHRONIC RADIATION PROCTITIS. Mehdi Kaassis, Frederic Oberti, Pascal Burtin, Jean Boyer, Univ Hosp, Angers, France; Inversity Hosp, Angers, France. The treatment of rectal bleeding due to radiation proctitis is difficult to manage. Argon Plasma Coagulation (APC) is a technique of electrocoagulation which appears to be an effective and low-cost alternative to laser therapy. Aims. Our aim was to evaluate the efficacy and tolerance of APC for treatment of bleeding radiation-induced proctitis. Patients. We retrospectively analyzed the charts of 16 patients with chronic radiation proctitis. The mean age was 73.5 years (range: 62-80). Primary tumor was a prostatic cancer (No=15) and a uterine cancer (No=1). The mean time of onset of symptoms after radiotherapy was 15 months (range: 6-36). All patients complained of intermittent or daily rectal bleeding, of whom 3 needed blood transfusions. After a first colonoscopic evaluation, the patients underwent APC therapy at 1 month intervals. Argon gas flow was set at 0.6 L/min with an electrical power of 40 Watts. Results. All patients were improved by APC and a mean of 3.7 sessions (range: 2-8) was necessary for symptoms relief. During a mean follow-up of 7 months (range: 2-21 months), rectal bleeding did not recur in 7 patients (43.7%); in the other 9 patients (56.3%), bleeding was significantly reduced to occasional and negligible spotting (1 bleeding episode per week). No patient required transfusion after treatment. Immediate tolerance was good and no long-term treatment-related complication was observed. Conclusions. APC is an effective, safe and well tolerated treatment for rectal bleeding due to chronic radiation proctitis and might be considered as a first-line therapy for radiation proctitis.
*4485 INCIDENCE OF DEPRESSED COLORECTAL NEOPLASIA IN SOUTHERN BRAZIL. Claudio Rolim Teixeira, Jorge Muller Griebeler, Eunice Bernardes Tonelotto, Nelson Vieira Coelho, Ronaldo Spinatto Torresini, Carlos Saul, Anis Kurban, Reinaldo Balduino Petter, Fugast, Porto Alegre, Brazil. Flat and depressed colorectal lesions despite being increasingly reported in Japan, are still a matter of controversy in western countries and the true incidence of these lesions is poorly undestood. The AIM of this study is to evaluate the incidence of depressed lesions diagnosed on routine colonoscopy in a brazilian endoscopic center. METHODS During January 1996 to May 1999, all total colonoscopies performed with magnifying colonoscope(Fujinon410CM) allowing up to 40x magnification of the standard videoimage, were included in the analysis. Patients with familial polyposis and inflammatory bowel disease were excluded. Macroscopically, colorectal neoplastic lesions were classified as polyps, flat elevated lesions, depressed lesions(IIc) and lateral spreading tumors. On colonoscopy the lesions were examined in detail by chromoscopy with indigo-carmine 2% and/or pyoktanin-blue 0.5% and the pit pattern on the surface of the lesion was determined as Kudo’s classification. All lesions were resected by polypectomy or endoscopic mucosal resection (EMR). RESULTS Among 1930 total colonoscopies, 13 depressed lesions (0.7%) were diagnosed. Size of the lesions varied from 1.4 to 7mm in diameter. Seven lesions were located in the sigmoid, 3 in ascending, 2 in the transverse and 1 in the descending colon. Histologic diagnosis was carcinoma in 6 lesions, adenoma with high-grade dysplasia in 5 lesions and low grade in 2 lesions. Pit pattern of the depressed lesions were IIIs in 9 lesions, V in 3 lesions and IV in one lesion. Other diagnosed lesions in this group of patients were 1594 polyps, 63 flat elevated lesions and 51 lateral spreading tumors. CONCLUSIONS Depressed colorectal neoplasia exhibiting the same features as reported by japanese investigators were also diagnosed in our group of patients. Despite the small size and low incidence (0.7%) of depressed lesions, the high frequency of carcinoma and high-grade dysplasia diagnosed in these lesions emphasize the need for the endoscopic diagnosis and resection of these lesions to prevent colorectal cancer.
VOLUME 51, NO. 4, PART 2, 2000
GASTROINTESTINAL ENDOSCOPY
AB147
*4484 COLONOSCOPIC FINDINGS IN INTESTINAL BEHCET’S DISEASE. Won Ho Kim, Chung Ryul Lee, Yong Suk Cho, Jeong Youp Park, Myung Whan Kim, In Suh Park, Yonsei Univ Coll of Medicine, Seoul, South Korea. Background: Behcet’s disease is a multisystemic chronic inflammatory disease characterized by oral ulcer, genital ulcer, skin manifestations and ocular involvements as major symptoms. Minor symtoms include arthritis or arthralgia, vascular lesion, CNS involvement, epididymitis, and intestinal ulcers. Intestinal involvement in Behcet’s disease is not rare in Korea. Ulceration can occur in any part of the gastrointestinal tract including the esophagus, stomach and duodenum, but the ileo-cecal area is the most commonly involved site. Aim: The aim of this study was to characterize the colonoscopic findings of intestinal Behcet’s disease. Methods: We retrospectively reviewed colonoscopic examinations in 92 patients with intestinal Behcet’s disease. Among 92 patients, complete, incomplete, suspicious, and possible types included 16, 26, 24, and 18 cases, respectively. The remaining 8 cases did not have any major systemic manifestation of Behcet’s disease. About 2/3 of the patients were diagnosed as Behcet’s disease before intestinal involvement was identified. Twenty-four (26%) patients had a previous history of intestinal resection at the time of colonoscopy. Results: Abdominal pain (94%) was the most common symptom, followed by diarrhea (30%), melena/hematochezia (25%), weight loss, fever, indigestion and nausea/ vomiting. Colonoscopy demonstrated ulcerative lesions in all cases. Among patients who did not have operations, ileo-cecal area was the most commonly involved site (92%). Seven (8%) patients had ulcers in other parts of the colon. All of the operated patients had ulcers at the ileo-colonic anastomostic site. Most (95%) of the ulcers were round/oval or geographic in shape while longitudinal or circumferential ulcers were rare (5%). Sixty-one patients (66%) had a single ulcer, 19 (21%) had several (2-5) ulcers, and 12 (13%) had multiple (≥6) ulcers. The ulcer was small (≤ 10 mm) in 20 patients (22%), medium-sized (11-20 mm) in 20 (22%), and large (> 20 mm) in 52 patients (57%). Mean size of ulcer was 3.0 cm. The ulcer was deep in 56 patients (61%) while shallow in 36 (39%). The margin of ulcer was discrete in 75 cases (82%), elevated and nodular in 56 cases (62%), and erythematous in 48 cases (52%). Mucosal changes adjacent to the ulceration such as erhthema and edema were not common, and were noted in 22 cases (24%). Conclusion: Typical colonoscopic finding in intestinal Behcet’s disease included a single or a few deep ulcers with discrete margin and normal adjacent mucosa in the ileocecal area or ileo-colonic anastomotic site.
*4483 ARGON PLASMA COAGULATION IS AN EFFECTIVE AND WELL TOLERATED TREATMENT FOR RECTAL BLEEDING DUE TO CHRONIC RADIATION PROCTITIS. Mehdi Kaassis, Frederic Oberti, Pascal Burtin, Jean Boyer, Univ Hosp, Angers, France; Inversity Hosp, Angers, France. The treatment of rectal bleeding due to radiation proctitis is difficult to manage. Argon Plasma Coagulation (APC) is a technique of electrocoagulation which appears to be an effective and low-cost alternative to laser therapy. Aims. Our aim was to evaluate the efficacy and tolerance of APC for treatment of bleeding radiation-induced proctitis. Patients. We retrospectively analyzed the charts of 16 patients with chronic radiation proctitis. The mean age was 73.5 years (range: 62-80). Primary tumor was a prostatic cancer (No=15) and a uterine cancer (No=1). The mean time of onset of symptoms after radiotherapy was 15 months (range: 6-36). All patients complained of intermittent or daily rectal bleeding, of whom 3 needed blood transfusions. After a first colonoscopic evaluation, the patients underwent APC therapy at 1 month intervals. Argon gas flow was set at 0.6 L/min with an electrical power of 40 Watts. Results. All patients were improved by APC and a mean of 3.7 sessions (range: 2-8) was necessary for symptoms relief. During a mean follow-up of 7 months (range: 2-21 months), rectal bleeding did not recur in 7 patients (43.7%); in the other 9 patients (56.3%), bleeding was significantly reduced to occasional and negligible spotting (1 bleeding episode per week). No patient required transfusion after treatment. Immediate tolerance was good and no long-term treatment-related complication was observed. Conclusions. APC is an effective, safe and well tolerated treatment for rectal bleeding due to chronic radiation proctitis and might be considered as a first-line therapy for radiation proctitis.
*4485 INCIDENCE OF DEPRESSED COLORECTAL NEOPLASIA IN SOUTHERN BRAZIL. Claudio Rolim Teixeira, Jorge Muller Griebeler, Eunice Bernardes Tonelotto, Nelson Vieira Coelho, Ronaldo Spinatto Torresini, Carlos Saul, Anis Kurban, Reinaldo Balduino Petter, Fugast, Porto Alegre, Brazil. Flat and depressed colorectal lesions despite being increasingly reported in Japan, are still a matter of controversy in western countries and the true incidence of these lesions is poorly undestood. The AIM of this study is to evaluate the incidence of depressed lesions diagnosed on routine colonoscopy in a brazilian endoscopic center. METHODS During January 1996 to May 1999, all total colonoscopies performed with magnifying colonoscope(Fujinon410CM) allowing up to 40x magnification of the standard videoimage, were included in the analysis. Patients with familial polyposis and inflammatory bowel disease were excluded. Macroscopically, colorectal neoplastic lesions were classified as polyps, flat elevated lesions, depressed lesions(IIc) and lateral spreading tumors. On colonoscopy the lesions were examined in detail by chromoscopy with indigo-carmine 2% and/or pyoktanin-blue 0.5% and the pit pattern on the surface of the lesion was determined as Kudo’s classification. All lesions were resected by polypectomy or endoscopic mucosal resection (EMR). RESULTS Among 1930 total colonoscopies, 13 depressed lesions (0.7%) were diagnosed. Size of the lesions varied from 1.4 to 7mm in diameter. Seven lesions were located in the sigmoid, 3 in ascending, 2 in the transverse and 1 in the descending colon. Histologic diagnosis was carcinoma in 6 lesions, adenoma with high-grade dysplasia in 5 lesions and low grade in 2 lesions. Pit pattern of the depressed lesions were IIIs in 9 lesions, V in 3 lesions and IV in one lesion. Other diagnosed lesions in this group of patients were 1594 polyps, 63 flat elevated lesions and 51 lateral spreading tumors. CONCLUSIONS Depressed colorectal neoplasia exhibiting the same features as reported by japanese investigators were also diagnosed in our group of patients. Despite the small size and low incidence (0.7%) of depressed lesions, the high frequency of carcinoma and high-grade dysplasia diagnosed in these lesions emphasize the need for the endoscopic diagnosis and resection of these lesions to prevent colorectal cancer.
VOLUME 51, NO. 4, PART 2, 2000
GASTROINTESTINAL ENDOSCOPY
AB147