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Efficacy of Home Enteral Nutrition for the Treatment of Pancreatitis Using Standard Enteral Formula
Abstracts
M1341 Non-Surgical Management of Microperforation Induced by EMR of the Stomach Gyu Jeong, Jun Haeng Lee, Poong-Lyul Rhee, Jae J. Kim, Seung Woon Paik, Jong Chul Rhee Background: Perforation and bleeding are the major complications associated with EMR of the stomach. Evident perforation during EMR procedure can be managed by endoscopic clipping. However, management of patients with microperforation (free air on chest X-ray in a patient without evident perforation during the procedure) is not well established. Patient and method: From January 2002 to June 2004, total 409 lesions (109 early gastric cancers, 300 adenomas) have been treated by EMR method including precutting step. Iatrogenic perforations occurred in 4.16% (n Z 17) of EMR. We have encountered microperforations in 3.18% (n Z 13), after 4 evident perforations were excluded. Results: Two patients were treated surgically (uncontrolled bleeding, incomplete resection of gastric cancer). Remaining 11 patients with microperforation were successfully recovered by nonsurgical managements (fasting, nasogastric tube drainage, intravenous antibiotics) and without additional endoscopic treatment. In these 11 patients, 2 patients had only mild discomfort that needed no analgesics and 2 patients had no symptom. ´ was seen in one patient (9.1%), leukocytosis Body temperature above 37.5 ¡E above 9,000xx in 8 patients (72.7%) on first day after perforation. But most of them normalized on second day. The mean duration of nasogastric tube drainage was 2.75 ¡3⁄4 1.29 days, fasting 4.25 ¡3⁄4 1.14 days, intravenous antibiotics 5.67 ¡3⁄4 1.44 days, hospitalization 7.41 ¡3⁄4 1.31 days. On chest X-ray before diet start and discharge, 10 out of 11 patients had free air. Conclusion: Microscopic perforations induced by gastric EMR can be managed non-surgically, including fasting, nasogastric tube drainage and intravenous antibiotics.
evaluation of patients receiving long-term EN for pancreatitis between Sept 95 and Sept 04 was performed. Most patients received EN after placement of a PEG-J. Under fluoroscopy, using a pediatric bronchoscope inserted through the PEG, a stiff guide wire is placed beyond the ligament of Treitz through the working channel of the bronchoscope. The bronchoscope is then exchanged for a J arm over the wire. Injection of contrast is then used to confirm placement in the jejunum. Etiology of pancreatitis, clinical signs, duration and mode of feeding were documented as well as Balthazar score (BS) before and at the end of EN. The criteria for effectiveness included clinical improvement associated with a BS % 2. Results were evaluated by a paired t test. Results: 112 patients (72 male, 40 female), mean age: 49 y.o (range: 19-81) were identified. Etiology included 47 alcohol, 41 gallstone, 11 idiopathic, 8 post ERCP pancreatitis, 2 medication (Immuran), 2 pancreas divisum and 1 hyperlipidemia. Median feeding time was 3 months (range: 0.5-16) with PEG-J placed in 96 (85%), PEJ in 3 (3%) and NJ in 13 (12%) patients. Eighty-one patients (72%) clinically improved with mean BS before enteral feeding of 4 (range: 1-6), and at the end of enteral feeding of 1.6 (range: 0-7), with a p value ! 0.001. Conclusion: Long term enteral feeding using SEF is an effective and cost-saving alternative in the treatment of pancreatitis. Prospective studies comparing these two types of EN are required.
M1342 Recurrence After Endoscopic Resection for Early Gastric Cancer in Korea Hwoon-Yong Jung, Gin-Hyug Lee, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Weon-Seon Hong, Jin-Ho Kim, Young Il Min Background/Aim: Nowadays, some patients with early gastric cancer (EGC) can be cured by endoscopic mucosal resection (EMR). We analyzed the patients who undertaken EMR because of differentiated mucosal cancer without ulcer to determine the long-term result of EMR procedure as a curative measure for EGC. Methods: A total of 310 EGC patients was enrolled this study between Jun. 1995 and Jun. 2002. Among them, 288 patients with complete resection were evaluated for recurrence. Results: Four (1.4%) patients were recurred during 47 months’ median follow-up period. One of them presented as lymph node metastasis without intragastric recurrence. The median duration between EMR and local recurrence was 21 months. Three (1%) were noticed as metachronous EGC at other site of stomach. The median duration between EMR and detection of metachronous EGC was 29 months. There was no difference in recurrence rate in terms of size (!3 cm vs. size O3 cm Z 1.2% vs. 2.9%) and the number of resection (En Bloc vs. multiple resection Z 1.5% vs. 1.1%). The 5-year survival rate after EMR was 90%, however, there was no death with gastric cancer till now. In conclusion, the recurrence rate in the patients with complete resection was 1.4% after EMR. Conclusions: The complete resection might be important for the cure of EGC.
M1343 Efficacy of Home Enteral Nutrition for the Treatment of Pancreatitis Using Standard Enteral Formula Michel Kahaleh, Joe Krenitsky, Jesse Liu, Carol Parrish, Paul Yeaton Objective: Enteral feeding distal to the ligament of Treitz has been shown to be an effective therapy in patients with pancreatitis, presumably by decreasing pancreatic stimulation. Enteral nutrition (EN) using elemental formulas has gained acceptance, however, few data are available regarding long term management of patients on home EN using standard enteral formula (SEF). Methods: Prospective
AB168 GASTROINTESTINAL ENDOSCOPY Volume 61, No. 5 : 2005
M1344 The Influence of H pylori Infection on the Healing Process of Gastric Ulcers After Endoscopic Submucosal Dissection Naomi Kakushima, Naohisa Yahagi, Mitsuhiro Fujishiro, Shinya Kodashima, Masanori Nakamura, Masao Omata Background & Aim: FEndoscopic submucosal dissection (ESD) is rapidly becoming popular for treatment of mucosal tumors in the GI tract, especially for larger lesions difficult for conventional EMR. We have previously reported that gastric artificial ulcers after ESD would heal within 8 weeks regardless of size and its location, if there is no preoperative fibrosis under the lesion. In this study, we examined the influence of Helicobacter Pylori (HP) infection on the healing process of gastric ulcers after ESD. Method: From 2000 to 2003, 79 patients (male 65, female 14) who underwent ESD for mucosal tumors, and of which infectious state of HP was confirmed either pathologically or serologically, were included. The healing stage, pattern of scar formation was studied at follow up endoscopy performed within 6 to 8 weeks after the treatment. Normal doses of PPI and sucralfate were given for 8 weeks for postoperative medication. In addition, patients whose serum pepsinogen (PG) was evaluated before treatment (66 patients), were divided in 3 groups; PG positive (PG I ! 70 and I/II ! 3), strongly positive (PG ! 30 and I/II ! 2) and negative, according to Miki et al, to study the influence of atrophic gastritis on ulcer healing. Result: The average specimen size removed by ESD was 34 mm (range 20 to 90 mm). In 60 cases (76%), the ulcer contracted in the short axis (axial direction) of the stomach, resulting in linear scars along the long axis (sagittal direction). In 19 cases (24%), the ulcer contracted nearly in a concentric form, resulting in an asteroid scar. In 5 patients, a small mucosal defect was still observed at follow up, of which ulcerative findings were present before treatment. Infection of HP was positive in 68 patients, negative in 11 patients (previously eradicated 3, negative with atrophic gastritis 7, negative without atrophic gastritis 1). There were no significant difference in the healing stage or scar formation regarding HP infection state. Patients of PG positive, strongly positive and negative were 36, 15 and 15 patients, respectively. There were no significant difference among the 3 groups. Conclusion: Infection of HP or the degree of atrophic gastritis have no influence on the healing process of gastric ulcers after ESD.
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M1341 Non-Surgical Management of Microperforation Induced by EMR of the Stomach Gyu Jeong, Jun Haeng Lee, Poong-Lyul Rhee, Jae J. Kim, Seung Woon Paik, Jong Chul Rhee Background: Perforation and bleeding are the major complications associated with EMR of the stomach. Evident perforation during EMR procedure can be managed by endoscopic clipping. However, management of patients with microperforation (free air on chest X-ray in a patient without evident perforation during the procedure) is not well established. Patient and method: From January 2002 to June 2004, total 409 lesions (109 early gastric cancers, 300 adenomas) have been treated by EMR method including precutting step. Iatrogenic perforations occurred in 4.16% (n Z 17) of EMR. We have encountered microperforations in 3.18% (n Z 13), after 4 evident perforations were excluded. Results: Two patients were treated surgically (uncontrolled bleeding, incomplete resection of gastric cancer). Remaining 11 patients with microperforation were successfully recovered by nonsurgical managements (fasting, nasogastric tube drainage, intravenous antibiotics) and without additional endoscopic treatment. In these 11 patients, 2 patients had only mild discomfort that needed no analgesics and 2 patients had no symptom. ´ was seen in one patient (9.1%), leukocytosis Body temperature above 37.5 ¡E above 9,000xx in 8 patients (72.7%) on first day after perforation. But most of them normalized on second day. The mean duration of nasogastric tube drainage was 2.75 ¡3⁄4 1.29 days, fasting 4.25 ¡3⁄4 1.14 days, intravenous antibiotics 5.67 ¡3⁄4 1.44 days, hospitalization 7.41 ¡3⁄4 1.31 days. On chest X-ray before diet start and discharge, 10 out of 11 patients had free air. Conclusion: Microscopic perforations induced by gastric EMR can be managed non-surgically, including fasting, nasogastric tube drainage and intravenous antibiotics.
evaluation of patients receiving long-term EN for pancreatitis between Sept 95 and Sept 04 was performed. Most patients received EN after placement of a PEG-J. Under fluoroscopy, using a pediatric bronchoscope inserted through the PEG, a stiff guide wire is placed beyond the ligament of Treitz through the working channel of the bronchoscope. The bronchoscope is then exchanged for a J arm over the wire. Injection of contrast is then used to confirm placement in the jejunum. Etiology of pancreatitis, clinical signs, duration and mode of feeding were documented as well as Balthazar score (BS) before and at the end of EN. The criteria for effectiveness included clinical improvement associated with a BS % 2. Results were evaluated by a paired t test. Results: 112 patients (72 male, 40 female), mean age: 49 y.o (range: 19-81) were identified. Etiology included 47 alcohol, 41 gallstone, 11 idiopathic, 8 post ERCP pancreatitis, 2 medication (Immuran), 2 pancreas divisum and 1 hyperlipidemia. Median feeding time was 3 months (range: 0.5-16) with PEG-J placed in 96 (85%), PEJ in 3 (3%) and NJ in 13 (12%) patients. Eighty-one patients (72%) clinically improved with mean BS before enteral feeding of 4 (range: 1-6), and at the end of enteral feeding of 1.6 (range: 0-7), with a p value ! 0.001. Conclusion: Long term enteral feeding using SEF is an effective and cost-saving alternative in the treatment of pancreatitis. Prospective studies comparing these two types of EN are required.
M1342 Recurrence After Endoscopic Resection for Early Gastric Cancer in Korea Hwoon-Yong Jung, Gin-Hyug Lee, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Weon-Seon Hong, Jin-Ho Kim, Young Il Min Background/Aim: Nowadays, some patients with early gastric cancer (EGC) can be cured by endoscopic mucosal resection (EMR). We analyzed the patients who undertaken EMR because of differentiated mucosal cancer without ulcer to determine the long-term result of EMR procedure as a curative measure for EGC. Methods: A total of 310 EGC patients was enrolled this study between Jun. 1995 and Jun. 2002. Among them, 288 patients with complete resection were evaluated for recurrence. Results: Four (1.4%) patients were recurred during 47 months’ median follow-up period. One of them presented as lymph node metastasis without intragastric recurrence. The median duration between EMR and local recurrence was 21 months. Three (1%) were noticed as metachronous EGC at other site of stomach. The median duration between EMR and detection of metachronous EGC was 29 months. There was no difference in recurrence rate in terms of size (!3 cm vs. size O3 cm Z 1.2% vs. 2.9%) and the number of resection (En Bloc vs. multiple resection Z 1.5% vs. 1.1%). The 5-year survival rate after EMR was 90%, however, there was no death with gastric cancer till now. In conclusion, the recurrence rate in the patients with complete resection was 1.4% after EMR. Conclusions: The complete resection might be important for the cure of EGC.
M1343 Efficacy of Home Enteral Nutrition for the Treatment of Pancreatitis Using Standard Enteral Formula Michel Kahaleh, Joe Krenitsky, Jesse Liu, Carol Parrish, Paul Yeaton Objective: Enteral feeding distal to the ligament of Treitz has been shown to be an effective therapy in patients with pancreatitis, presumably by decreasing pancreatic stimulation. Enteral nutrition (EN) using elemental formulas has gained acceptance, however, few data are available regarding long term management of patients on home EN using standard enteral formula (SEF). Methods: Prospective
AB168 GASTROINTESTINAL ENDOSCOPY Volume 61, No. 5 : 2005
M1344 The Influence of H pylori Infection on the Healing Process of Gastric Ulcers After Endoscopic Submucosal Dissection Naomi Kakushima, Naohisa Yahagi, Mitsuhiro Fujishiro, Shinya Kodashima, Masanori Nakamura, Masao Omata Background & Aim: FEndoscopic submucosal dissection (ESD) is rapidly becoming popular for treatment of mucosal tumors in the GI tract, especially for larger lesions difficult for conventional EMR. We have previously reported that gastric artificial ulcers after ESD would heal within 8 weeks regardless of size and its location, if there is no preoperative fibrosis under the lesion. In this study, we examined the influence of Helicobacter Pylori (HP) infection on the healing process of gastric ulcers after ESD. Method: From 2000 to 2003, 79 patients (male 65, female 14) who underwent ESD for mucosal tumors, and of which infectious state of HP was confirmed either pathologically or serologically, were included. The healing stage, pattern of scar formation was studied at follow up endoscopy performed within 6 to 8 weeks after the treatment. Normal doses of PPI and sucralfate were given for 8 weeks for postoperative medication. In addition, patients whose serum pepsinogen (PG) was evaluated before treatment (66 patients), were divided in 3 groups; PG positive (PG I ! 70 and I/II ! 3), strongly positive (PG ! 30 and I/II ! 2) and negative, according to Miki et al, to study the influence of atrophic gastritis on ulcer healing. Result: The average specimen size removed by ESD was 34 mm (range 20 to 90 mm). In 60 cases (76%), the ulcer contracted in the short axis (axial direction) of the stomach, resulting in linear scars along the long axis (sagittal direction). In 19 cases (24%), the ulcer contracted nearly in a concentric form, resulting in an asteroid scar. In 5 patients, a small mucosal defect was still observed at follow up, of which ulcerative findings were present before treatment. Infection of HP was positive in 68 patients, negative in 11 patients (previously eradicated 3, negative with atrophic gastritis 7, negative without atrophic gastritis 1). There were no significant difference in the healing stage or scar formation regarding HP infection state. Patients of PG positive, strongly positive and negative were 36, 15 and 15 patients, respectively. There were no significant difference among the 3 groups. Conclusion: Infection of HP or the degree of atrophic gastritis have no influence on the healing process of gastric ulcers after ESD.
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