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A Prospective Randomized Trial of Either Lafutidine Or Rabeprazole On Healing of Iatrogenic Gastric Ulcers After Endoscopic Submucosal Dissection
Abstracts
W1424 Colonoscopy in Women: Is It Still More Difficult Than Colonoscopy in Men and Is a Low BMI Still a Challenge? Joseph C. Anderson, Michael Dorfman, Zvi Alpern, Jared Gold, Ramona Rajapakse, Ravi Ainapudi, Edward Zurcher, William Smithy, Kevin Sano Background: We have previously identified that women may be more difficult to perform colonoscopy on than men (Anderson et al AJG 2000). We have also observed that thinner women were more difficult than their heavier counterparts. These studies have been performed with an adult colonoscope. Recently Aslinia et al (AJG 2006) published data showing an increasing use of thinner scopes such as the pediatric colonoscope. Our primary goal was to determine if the difficulty with female patients, especially thin women, is still encountered with the increasing use of the thinner scopes. Methods: We collected age, gender, surgical history, bowel habits history, type of colonoscope used, time to cecum and anatomic location of scope tip when a problem was encountered. Results: Data from 977 colonoscopies performed by 7 experienced (O5 years post fellowship) endoscopists were collected. Male patients had a higher completion rate. Endoscopists were more likely to use thinner scopes in female patients (see Table 1). Female patients were also more likely to have incomplete exams and longer cecal intubation times. Overall the completion rates of both genders were high. In addition, they were more likely to use the thinner colonscopes in thinner females than heavier females (see Table 2). Lower BMI was a predictor of a longer exam for both genders (p Z 0.016 for women; p ! 0.05 for men). Conclusions: Despite the use of thinner scopes, women, especially those that are thin, still provide a challenge to the endoscopist. More technologic changes may be needed to help screen women more efficiently for colorectal cancer. Comparison of male and female patients Male (n Z 515)
Female (n Z 463)
99.4% 85.1% 4.9
97.4% 31.1% 5.8
p-value )0.01 )0.001 )0.001
Women (BMI ! 25) (n Z 188)
Women (BMI O 25) (n Z 275)
p-value
97.3% 12.2% 6.1
97.5% 49.6% 5.6
0.96 )0.001 )0.05
Cecal intubation rate Adult scope used Time to cecum
Comparison of women by BMI
Cecal intubation rate Adult scope used Time to cecum (mean in min)
W1425 A Comparison Between Unsedated Transnasal Esophagogastroduodenoscopy (EGD) and Transoral EGD in a General Hospital: The Analysis of 2,500 Patients Satoshi Ikeda, Takeshi Ohki, Hirofumi Okamura, Kenji Furukawa, Makoto Ikeda Background & Aims: Recently, transnasal esophagogastroduodenoscopy (EGD) has been used for gentle and safe endoscoic examinations. However at the current time, this technique has still not become a thoroughly accepted technique in Japanese general hospitals. Since 2005, examinations using transnasal EGD have been initiated as an alternative diagnostic technique. Under these conditions and at equal costs, patients have been offered a choice between transnasal EGD, transoral EGD, and fluoroscopy, for upper gastrointestinal examinations. In the present study, we investigated the use of transnasal EGD as a technique in Japanese general hospitals. Patients & Methods: Two thousand five hundred patients including both outpatients and inpatients were enrolled in this study. Subjects underwent EGD for screening of upper intestinal tract disorders at Ikeda Hospital between October 2005 and November 2006. Patients were surveyed using post-operative questionnaires after transnasal EGD. All patients receiving transnasal EGD were not treated with any sedatives. Results: Two thousand five hundred patients received medical examinations in our hospital for diagnostic procedures involving the upper intestinal tract. In the present study, 90% of patients that received routine medical examinations in our hospital, received transnasal EGD or transoral EGD, with 80% of patients selecting transnasal EGD after its introduction. Transnasal EGD was feasible in 98% of patients examined with 2% of patients changed transoral EGD from transnasal EGD because the nasal tube could not be inserted. The rate of detection in early gastric cancers, polyps, ulcerations was comparable to conventional EGD. Transnasal EGD required approximately one additional minute for diagnosis, compared with transoral EGD. 2% of patients suffered nasal hemorrhage as a complication. Overall, 91% of the patients who underwent both transnasal and transoral EGD, would prefer to undergo transnasal EGD at
www.giejournal.org
subsequent upper intestinal examinations. Conclusions: Transnasal EGD without sedatives is a useful alternative to transoral EGD for screening examination. This method that does not require the use of sedatives is excellent in risk management and transnasal EGD may be the method of choice for routine diagnostic measurements in upper gastrointestinal endoscopy for general hospital.
W1426 A Prospective Randomized Trial of Either Lafutidine Or Rabeprazole On Healing of Iatrogenic Gastric Ulcers After Endoscopic Submucosal Dissection Tomohiko R. Ohya, Nobuyuki Matsuhashi Background: Lafutidine is a new generation histamine H2 receptor antagonist (H2RA) which not only suppresses gastric acid secretion, but also has cytoprotective properties in gastric epithelial cells. In human gastric ulcer, proton pump inhibitors (PPIs) are reported to have greater anti-ulcer effects than H2RAs. In certain animal models of artificial gastric ulcer, however, cytoprotective agents exert greater anti-ulcer effects than H2RAs. Since gastric ulcers after endoscopic submucosal dissection (ESD) are artificial ones, there could be a possibility that laftidine, an H2RA with cytoprotective property, may exert equal or superior antiulcer effects than PPIs. Therefore, we examined anti-ulcer effects of laftidine and raberazole in post-ESD gastric ulcers. Methods: All patients had either an early gastric cancer or a gastric adenoma that was considered curable with endoscopic treatment. We treated the patients by ESD. After ESD, all patients were treated with intravenous omeprazole for the first 3 days. After that, patients were randomly assigned to lafutidine (group L; 20 mg/day) or to rabeprazole (group R; 10 mg/day) referring to there age, sex, and ESD ulcer size. 4 weeks later, the ulcer sizes, ulcer size reduction rate, and ulcer stages were evaluated. Results: A total of 65 patients were enrolled in this study. 33 and 32 cases were assigned to group L and group R, respectively, in a randomized fashion. In group L, initial and 4-w post-ESD ulcer sizes were 30.36.9 and 10.24.7 mm, respectively. In group R, each value was 32.610.4 and 11.06.5 mm, respectively. Ulcer size reduction rate in group L and group R were 34.1% and 33.5%, respectively. Ulcer stages at 4-w post ESD in group L were: A2; 5%, H1; 37%, H2; 45%, S1; 5%, S2; 5%, and stages in group R were: H1; 33%, H2; 50%, S1; 12%. Thus, there were no significant differences in ulcer size, ulcer size reduction rate, and proportion of ulcer stage between the two groups. Conclusion: In post-ESD gastric ulcers, there were no significant difference in therapeutic effects between lafutidine and rabeprazole. Considering the lower cost for lafutidine, lafutidine may be enough for such conditions.
W1427 Clinicopathologic Characteristics of Endoscopically Resected Early Colorectal Cancer Jung Mook Kang, Sang Gyun Kim, Jong in Yang, Byong Duk Ye, Jong Pil IM, Joo Sung Kim, Hyun Chae Jung, in Sung Song Background: Recently, early detection and endoscopic treatment for early colorectal cancer (ECC) has increased due to screening colonoscopy. The aim of this study was to evaluate the clinicopathologic characteristics of ECC diagnosed by endoscopic mucosal resection (EMR). Methods: A total of 2224 adenomatous polyps from 1215 patients were removed by EMR in Seoul National University Hospital from April 2005 to August 2006. A total of 106 polyps from 104 patients were diagnosed pathologically as ECC after EMR. Clinocopathologic features of ECC were analyzed retrospectively. Results: The mean age of the patients was 62 years old (range, 29-91) with a male : female ratio of 3 : 1. The mean size of the ECCs was 1.7 cm (range, 0.6-5) ; less than 1 cm in 14 (13%) ECCs, 1-2 cm in 55 (52%), 2 cm or more in 37 (35%). Most of ECCs (86%) were located in the left-sided colon and macroscopic appearances were pedunculated (Ip)-type in 33%, semipedunculated (Isp)-type in 26%, sessile (Is)-type in 29% and laterally spreading tumor (LST)-type in 11%, respectively. Sixty-eight (64%) ECCs were mucosal cancer (m-cancer) and 38 (36%) were submucosal cancer (sm-cancer). En bloc and complete resection rate was 82% and 87% for m-cancer, 90% and 71% for sm-cancer, respectively (P Z 0.05). In univariate analysis, whereas sessile morphology, multiplicity, poor differentiation, the presence of lymphovascular invasion and the absence of an adenomatous component were significantly associated with sm-cancer (P ! 0.01), the size or location of ECC was not associated with submucosal invasion. Lymph node metastasis was found in 2 patients with sm-cancer among the 5 patients who underwent subsequent surgical resection due to unfavorable histology. Twenty lesions (56%, 20/36) diagnosed as adenoma on forcep biopsy before EMR proved to be an adenocarcinoma after EMR. Conclusion: In our study, the incidence of ECC after EMR for colorectal polyp was 4.8%. All polyps observed during colonoscopy should be completely resected for the possibility of malignancy irrespective of size or histology obtained by prior forcep biopsy.
Volume 65, No. 5 : 2007 GASTROINTESTINAL ENDOSCOPY AB363
W1424 Colonoscopy in Women: Is It Still More Difficult Than Colonoscopy in Men and Is a Low BMI Still a Challenge? Joseph C. Anderson, Michael Dorfman, Zvi Alpern, Jared Gold, Ramona Rajapakse, Ravi Ainapudi, Edward Zurcher, William Smithy, Kevin Sano Background: We have previously identified that women may be more difficult to perform colonoscopy on than men (Anderson et al AJG 2000). We have also observed that thinner women were more difficult than their heavier counterparts. These studies have been performed with an adult colonoscope. Recently Aslinia et al (AJG 2006) published data showing an increasing use of thinner scopes such as the pediatric colonoscope. Our primary goal was to determine if the difficulty with female patients, especially thin women, is still encountered with the increasing use of the thinner scopes. Methods: We collected age, gender, surgical history, bowel habits history, type of colonoscope used, time to cecum and anatomic location of scope tip when a problem was encountered. Results: Data from 977 colonoscopies performed by 7 experienced (O5 years post fellowship) endoscopists were collected. Male patients had a higher completion rate. Endoscopists were more likely to use thinner scopes in female patients (see Table 1). Female patients were also more likely to have incomplete exams and longer cecal intubation times. Overall the completion rates of both genders were high. In addition, they were more likely to use the thinner colonscopes in thinner females than heavier females (see Table 2). Lower BMI was a predictor of a longer exam for both genders (p Z 0.016 for women; p ! 0.05 for men). Conclusions: Despite the use of thinner scopes, women, especially those that are thin, still provide a challenge to the endoscopist. More technologic changes may be needed to help screen women more efficiently for colorectal cancer. Comparison of male and female patients Male (n Z 515)
Female (n Z 463)
99.4% 85.1% 4.9
97.4% 31.1% 5.8
p-value )0.01 )0.001 )0.001
Women (BMI ! 25) (n Z 188)
Women (BMI O 25) (n Z 275)
p-value
97.3% 12.2% 6.1
97.5% 49.6% 5.6
0.96 )0.001 )0.05
Cecal intubation rate Adult scope used Time to cecum
Comparison of women by BMI
Cecal intubation rate Adult scope used Time to cecum (mean in min)
W1425 A Comparison Between Unsedated Transnasal Esophagogastroduodenoscopy (EGD) and Transoral EGD in a General Hospital: The Analysis of 2,500 Patients Satoshi Ikeda, Takeshi Ohki, Hirofumi Okamura, Kenji Furukawa, Makoto Ikeda Background & Aims: Recently, transnasal esophagogastroduodenoscopy (EGD) has been used for gentle and safe endoscoic examinations. However at the current time, this technique has still not become a thoroughly accepted technique in Japanese general hospitals. Since 2005, examinations using transnasal EGD have been initiated as an alternative diagnostic technique. Under these conditions and at equal costs, patients have been offered a choice between transnasal EGD, transoral EGD, and fluoroscopy, for upper gastrointestinal examinations. In the present study, we investigated the use of transnasal EGD as a technique in Japanese general hospitals. Patients & Methods: Two thousand five hundred patients including both outpatients and inpatients were enrolled in this study. Subjects underwent EGD for screening of upper intestinal tract disorders at Ikeda Hospital between October 2005 and November 2006. Patients were surveyed using post-operative questionnaires after transnasal EGD. All patients receiving transnasal EGD were not treated with any sedatives. Results: Two thousand five hundred patients received medical examinations in our hospital for diagnostic procedures involving the upper intestinal tract. In the present study, 90% of patients that received routine medical examinations in our hospital, received transnasal EGD or transoral EGD, with 80% of patients selecting transnasal EGD after its introduction. Transnasal EGD was feasible in 98% of patients examined with 2% of patients changed transoral EGD from transnasal EGD because the nasal tube could not be inserted. The rate of detection in early gastric cancers, polyps, ulcerations was comparable to conventional EGD. Transnasal EGD required approximately one additional minute for diagnosis, compared with transoral EGD. 2% of patients suffered nasal hemorrhage as a complication. Overall, 91% of the patients who underwent both transnasal and transoral EGD, would prefer to undergo transnasal EGD at
www.giejournal.org
subsequent upper intestinal examinations. Conclusions: Transnasal EGD without sedatives is a useful alternative to transoral EGD for screening examination. This method that does not require the use of sedatives is excellent in risk management and transnasal EGD may be the method of choice for routine diagnostic measurements in upper gastrointestinal endoscopy for general hospital.
W1426 A Prospective Randomized Trial of Either Lafutidine Or Rabeprazole On Healing of Iatrogenic Gastric Ulcers After Endoscopic Submucosal Dissection Tomohiko R. Ohya, Nobuyuki Matsuhashi Background: Lafutidine is a new generation histamine H2 receptor antagonist (H2RA) which not only suppresses gastric acid secretion, but also has cytoprotective properties in gastric epithelial cells. In human gastric ulcer, proton pump inhibitors (PPIs) are reported to have greater anti-ulcer effects than H2RAs. In certain animal models of artificial gastric ulcer, however, cytoprotective agents exert greater anti-ulcer effects than H2RAs. Since gastric ulcers after endoscopic submucosal dissection (ESD) are artificial ones, there could be a possibility that laftidine, an H2RA with cytoprotective property, may exert equal or superior antiulcer effects than PPIs. Therefore, we examined anti-ulcer effects of laftidine and raberazole in post-ESD gastric ulcers. Methods: All patients had either an early gastric cancer or a gastric adenoma that was considered curable with endoscopic treatment. We treated the patients by ESD. After ESD, all patients were treated with intravenous omeprazole for the first 3 days. After that, patients were randomly assigned to lafutidine (group L; 20 mg/day) or to rabeprazole (group R; 10 mg/day) referring to there age, sex, and ESD ulcer size. 4 weeks later, the ulcer sizes, ulcer size reduction rate, and ulcer stages were evaluated. Results: A total of 65 patients were enrolled in this study. 33 and 32 cases were assigned to group L and group R, respectively, in a randomized fashion. In group L, initial and 4-w post-ESD ulcer sizes were 30.36.9 and 10.24.7 mm, respectively. In group R, each value was 32.610.4 and 11.06.5 mm, respectively. Ulcer size reduction rate in group L and group R were 34.1% and 33.5%, respectively. Ulcer stages at 4-w post ESD in group L were: A2; 5%, H1; 37%, H2; 45%, S1; 5%, S2; 5%, and stages in group R were: H1; 33%, H2; 50%, S1; 12%. Thus, there were no significant differences in ulcer size, ulcer size reduction rate, and proportion of ulcer stage between the two groups. Conclusion: In post-ESD gastric ulcers, there were no significant difference in therapeutic effects between lafutidine and rabeprazole. Considering the lower cost for lafutidine, lafutidine may be enough for such conditions.
W1427 Clinicopathologic Characteristics of Endoscopically Resected Early Colorectal Cancer Jung Mook Kang, Sang Gyun Kim, Jong in Yang, Byong Duk Ye, Jong Pil IM, Joo Sung Kim, Hyun Chae Jung, in Sung Song Background: Recently, early detection and endoscopic treatment for early colorectal cancer (ECC) has increased due to screening colonoscopy. The aim of this study was to evaluate the clinicopathologic characteristics of ECC diagnosed by endoscopic mucosal resection (EMR). Methods: A total of 2224 adenomatous polyps from 1215 patients were removed by EMR in Seoul National University Hospital from April 2005 to August 2006. A total of 106 polyps from 104 patients were diagnosed pathologically as ECC after EMR. Clinocopathologic features of ECC were analyzed retrospectively. Results: The mean age of the patients was 62 years old (range, 29-91) with a male : female ratio of 3 : 1. The mean size of the ECCs was 1.7 cm (range, 0.6-5) ; less than 1 cm in 14 (13%) ECCs, 1-2 cm in 55 (52%), 2 cm or more in 37 (35%). Most of ECCs (86%) were located in the left-sided colon and macroscopic appearances were pedunculated (Ip)-type in 33%, semipedunculated (Isp)-type in 26%, sessile (Is)-type in 29% and laterally spreading tumor (LST)-type in 11%, respectively. Sixty-eight (64%) ECCs were mucosal cancer (m-cancer) and 38 (36%) were submucosal cancer (sm-cancer). En bloc and complete resection rate was 82% and 87% for m-cancer, 90% and 71% for sm-cancer, respectively (P Z 0.05). In univariate analysis, whereas sessile morphology, multiplicity, poor differentiation, the presence of lymphovascular invasion and the absence of an adenomatous component were significantly associated with sm-cancer (P ! 0.01), the size or location of ECC was not associated with submucosal invasion. Lymph node metastasis was found in 2 patients with sm-cancer among the 5 patients who underwent subsequent surgical resection due to unfavorable histology. Twenty lesions (56%, 20/36) diagnosed as adenoma on forcep biopsy before EMR proved to be an adenocarcinoma after EMR. Conclusion: In our study, the incidence of ECC after EMR for colorectal polyp was 4.8%. All polyps observed during colonoscopy should be completely resected for the possibility of malignancy irrespective of size or histology obtained by prior forcep biopsy.
Volume 65, No. 5 : 2007 GASTROINTESTINAL ENDOSCOPY AB363