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Mo1042 Outcomes of Colitis-Associated Dysplasia After Referral From the Community to a Tertiary Center
Abstracts
intraprocedural bleeds-controlled with clips and cautery. No blood transfusions were needed. There were no delayed bleeding events. See Table 1 and Table 2 for details. Conclusion: ESD can be performed safely and effectively in Western setting as well. Our en bloc resection rates, R0 resection rates and incidence of adverse events are comparable to Asian endoscopists. We need to develop effective training models in North America to train more interventional endoscopists in ESD.
Table 1. Demographics and lesion characteristics Variable Number of patients Number of ESDs Gastric Esophageal Colorectal Average of Procedure time Gastric Esophageal Colorectal Histopathology Tubular adenoma Tubullovillous adenoma Other Benign lesions Low grade dysplasia High grade dysplasia Intramucosal Adenocarcinoma in situ Squamous cell cancer in situ Invasive adenocarcinoma Invasive Squamous cell cancer Neuroendocrine tumors Lymphomas Granular cell tumor
Number, N(%)
195 202 165 195
84 84 59 13 12 min min min min 6 4 14 4 25 8 1 14 2 3 2 1
Table 2. Outcomes Variable En bloc resection Gastric Esophageal Colorectal R0 resection Gastric Esophageal Colorectal Total adverse events Intraprocedural bleeding Intraprocedural perforation Delayed bleeding Delayed perforation
Number, N (%) 81/84 (96.4) 57 12 12 70/84 (83.3) 48 10 12 6 (7.14) 3 (3.5) 2 (2.3) 0 (0) 1 (1.1)
Mo1042 Outcomes of Colitis-Associated Dysplasia After Referral From the Community to a Tertiary Center David Rubin*, Noa Krugliak Cleveland, Dylan M. Rodriquez Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL Background: The SCENIC consensus statement recommends that when dysplasia is found by a less experienced endoscopist using white light, referral to an expert endoscopist for high definition (HD) colonoscopy with chromoendoscopy should occur, but the evidence for such a recommendation was noted to be very low quality (Laine et al. GIE 2015). We assessed our “real world” experience with a variant of this type of referral practice. Methods: We used our IBD endoscopy database to identify UC patients referred from community gastroenterologists for a diagnosis of dysplasia to our tertiary IBD center for further assessment between 2008 and 2015. All patients included had confirmation of their dysplasia diagnosis by our expert GI pathologists and were subsequently scoped by a single expert endoscopist (DTR) with >10 years of chromoendoscopy experience. The decision between HD with NBI or HD with methylene blue (MB) chromoendoscopy was made based on available equipment and patient presentation. We reviewed risks of dysplasia, the type of procedure, the endoscopic and histologic findings, and whether the index lesions were identified, as well as any additional lesions that were found. With the exception of the rectum,
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lesions found within one segment of the index location were considered to be the same lesion. Upgrading or downgrading of lesions was also assessed. Results: 53 patients were referred for further evaluation of 85 index lesions (71 low-grade dysplasia (LGD), 7 high-grade dysplasia (HGD), 5 indefinite dysplasia, 1 cancer (CA), 3 sessile serrated lesions) that had been found on the 53 outside white light colonoscopies. At our center, 37 subsequent exams were performed with HD colonoscopy with methylene blue chromoscopy and the remaining exams were performed by HD white light with or without narrow band imaging (NBI). More of the index lesions were found using HD/MB (42% of 62 lesions) than using HD/NBI (17% of 23 lesions). In addition, HD/MB exams identified more additional neoplastic lesions per exam (12 lesions in 37 exams, 0.32 additional lesion/exam, including 2 CA and 1 HGD) than did the HD/NBI exams (3 lesions in 16 exams, 0.19 additional lesion/ exam, all LGD). Conclusions: This real world analysis of patients referred to a tertiary expert IBD endoscopist for further assessment of dysplasia demonstrates an important yield of additional lesions and findings that influence subsequent management. Patients who had HD scopes with MB chromoendoscopy were more likely to have their index reidentified as well as more likely to have identified additional advanced lesions of clinical significance. Although small, this series supports the evaluation of patients who have low-grade dysplasia found by white light exam by an expert endoscopist, and favors the use of HD with chromoendoscopy.
Mo1043 Long Term Outcome of Endoscopic Resection for Gastric Neoplasm in the Remnant Stomach After Subtotal Gastrectomy Hyun Ju Kim*, Jun Chul Park, Hyunsoo Chung, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee Internal Medicine, Institute of Gastroenterology, Yonsei University, Seoul, Korea (the Republic of) Background: Endoscopic resection (ER) for gastric neoplasm after subtotal gastrectomy is a technically difficult procedure because of the limited working space in the remnant stomach. The aim of this study is to analyze clinical and oncologic long term outcomes to deter mine the feasibility and effectiveness of ER in patients with gastric neoplasm in the remnant stomach after subtotal gastrectomy. Methods: A retrospective review was conducted on 61 patients who undergoing ER (16: EMR, 45: ESD) for gastric neoplasm in the remnant stomach from 2007-2014, using prospective data base. There were two groups depending on ER pathology of gastric lesions. (31: Adenoma group vs 30: cancer group). Results: A total of 61 consecutive patients with 61 lesions had previously undergone subtotal gastrectomy. The median period from the original gastrectomy to the subsequent ER for gastric neoplasm in the remnant stomach was 4 years (range 1-19 years). The mean age of cancer group was older than adenoma group (adenoma vs cancer; 65.1 (1.3) vs 69.9 (1.6); pZ0.024). The median tumor size was 12mm (range 1-47 mm) (adenoma vs cancer; 10mm, range (2-26) vs 13mm, range (1-47); pZ0.027), and the median procedure time was 42 minutes (adenoma vs cancer; 25min, range (8-128) vs 52.5min, range (23-165); pZ0.003). The en bloc resection rate was 90.2% (adenoma vs cancer; 93.5 % vs 86.7%; pZ0.031), Curative resection rate was 68.7% (adenoma vs cancer;87.1% vs 50.0%; pZ0.002). In non-curative resection cases of cancer group, horizontal margin positive was 7 cases, beyond indication were 7 cases, piecemeal resection was 4 cases, vertical margin positive was 3 cases. Adverse events included 2 cases of perforation (3.3%) and 2 cases of bleeding (3%) without emergent surgery. 5-year overall survival was 79.9% and 5-year disease free survival was 85.9% during a median follow-up period of 23.8 months (range 0.03-115.7 months), with no deaths from gastric cancer. All patients underwent regular endoscopy after subtotal gastrectomy during follow-up period. According to endoscopic surveillance interval (short [12 months] vs. long [>12 months]), there was a significant difference in proportion of histology (adenoma vs. adenocarcinoma, 12 months, 33.3% vs. 13.3%, >12 months, 66.7% vs. 86.7%, P Z 0.037). However, there was no difference of depth of the recurred adenocarcinoma and additional treatment modality (ESD or surgery) depends on endoscopy interval. Conclusions: ER for gastric neoplasm in the remnant stomach of patients after subtotal gastrectomy was a feasible and safe method. However, non-curative resection rate was higher in ER cases with EGC than adenoma, so careful decision for ER in patients with EGC after subtotal gastrectomy is required.
Mo1044 Comparison of Performance Characteristics of Endoluminal Bariatric Procedures between Gastroenterologists and Surgeons in the World: A Systematic Review and Meta-analysis Hongfeng Zhang* Department of Gastroenterology and Hepatology, University of Connecticut Health Center, West Hartford, CT Background: Endoluminal bariatric procedures are among the emerging techniques that are currently performed by both gastroenterologists and surgeons in the world. Endoscopic suturing and stapling techniques, despite their considerable limitations such as inadequate durability or threshold for treatment, have advantages including less pain, outpatient procedure, and a high level of patient acceptance. However, differences in performance of these techniques between gastroenterologists and
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB439
intraprocedural bleeds-controlled with clips and cautery. No blood transfusions were needed. There were no delayed bleeding events. See Table 1 and Table 2 for details. Conclusion: ESD can be performed safely and effectively in Western setting as well. Our en bloc resection rates, R0 resection rates and incidence of adverse events are comparable to Asian endoscopists. We need to develop effective training models in North America to train more interventional endoscopists in ESD.
Table 1. Demographics and lesion characteristics Variable Number of patients Number of ESDs Gastric Esophageal Colorectal Average of Procedure time Gastric Esophageal Colorectal Histopathology Tubular adenoma Tubullovillous adenoma Other Benign lesions Low grade dysplasia High grade dysplasia Intramucosal Adenocarcinoma in situ Squamous cell cancer in situ Invasive adenocarcinoma Invasive Squamous cell cancer Neuroendocrine tumors Lymphomas Granular cell tumor
Number, N(%)
195 202 165 195
84 84 59 13 12 min min min min 6 4 14 4 25 8 1 14 2 3 2 1
Table 2. Outcomes Variable En bloc resection Gastric Esophageal Colorectal R0 resection Gastric Esophageal Colorectal Total adverse events Intraprocedural bleeding Intraprocedural perforation Delayed bleeding Delayed perforation
Number, N (%) 81/84 (96.4) 57 12 12 70/84 (83.3) 48 10 12 6 (7.14) 3 (3.5) 2 (2.3) 0 (0) 1 (1.1)
Mo1042 Outcomes of Colitis-Associated Dysplasia After Referral From the Community to a Tertiary Center David Rubin*, Noa Krugliak Cleveland, Dylan M. Rodriquez Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL Background: The SCENIC consensus statement recommends that when dysplasia is found by a less experienced endoscopist using white light, referral to an expert endoscopist for high definition (HD) colonoscopy with chromoendoscopy should occur, but the evidence for such a recommendation was noted to be very low quality (Laine et al. GIE 2015). We assessed our “real world” experience with a variant of this type of referral practice. Methods: We used our IBD endoscopy database to identify UC patients referred from community gastroenterologists for a diagnosis of dysplasia to our tertiary IBD center for further assessment between 2008 and 2015. All patients included had confirmation of their dysplasia diagnosis by our expert GI pathologists and were subsequently scoped by a single expert endoscopist (DTR) with >10 years of chromoendoscopy experience. The decision between HD with NBI or HD with methylene blue (MB) chromoendoscopy was made based on available equipment and patient presentation. We reviewed risks of dysplasia, the type of procedure, the endoscopic and histologic findings, and whether the index lesions were identified, as well as any additional lesions that were found. With the exception of the rectum,
www.giejournal.org
lesions found within one segment of the index location were considered to be the same lesion. Upgrading or downgrading of lesions was also assessed. Results: 53 patients were referred for further evaluation of 85 index lesions (71 low-grade dysplasia (LGD), 7 high-grade dysplasia (HGD), 5 indefinite dysplasia, 1 cancer (CA), 3 sessile serrated lesions) that had been found on the 53 outside white light colonoscopies. At our center, 37 subsequent exams were performed with HD colonoscopy with methylene blue chromoscopy and the remaining exams were performed by HD white light with or without narrow band imaging (NBI). More of the index lesions were found using HD/MB (42% of 62 lesions) than using HD/NBI (17% of 23 lesions). In addition, HD/MB exams identified more additional neoplastic lesions per exam (12 lesions in 37 exams, 0.32 additional lesion/exam, including 2 CA and 1 HGD) than did the HD/NBI exams (3 lesions in 16 exams, 0.19 additional lesion/ exam, all LGD). Conclusions: This real world analysis of patients referred to a tertiary expert IBD endoscopist for further assessment of dysplasia demonstrates an important yield of additional lesions and findings that influence subsequent management. Patients who had HD scopes with MB chromoendoscopy were more likely to have their index reidentified as well as more likely to have identified additional advanced lesions of clinical significance. Although small, this series supports the evaluation of patients who have low-grade dysplasia found by white light exam by an expert endoscopist, and favors the use of HD with chromoendoscopy.
Mo1043 Long Term Outcome of Endoscopic Resection for Gastric Neoplasm in the Remnant Stomach After Subtotal Gastrectomy Hyun Ju Kim*, Jun Chul Park, Hyunsoo Chung, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee Internal Medicine, Institute of Gastroenterology, Yonsei University, Seoul, Korea (the Republic of) Background: Endoscopic resection (ER) for gastric neoplasm after subtotal gastrectomy is a technically difficult procedure because of the limited working space in the remnant stomach. The aim of this study is to analyze clinical and oncologic long term outcomes to deter mine the feasibility and effectiveness of ER in patients with gastric neoplasm in the remnant stomach after subtotal gastrectomy. Methods: A retrospective review was conducted on 61 patients who undergoing ER (16: EMR, 45: ESD) for gastric neoplasm in the remnant stomach from 2007-2014, using prospective data base. There were two groups depending on ER pathology of gastric lesions. (31: Adenoma group vs 30: cancer group). Results: A total of 61 consecutive patients with 61 lesions had previously undergone subtotal gastrectomy. The median period from the original gastrectomy to the subsequent ER for gastric neoplasm in the remnant stomach was 4 years (range 1-19 years). The mean age of cancer group was older than adenoma group (adenoma vs cancer; 65.1 (1.3) vs 69.9 (1.6); pZ0.024). The median tumor size was 12mm (range 1-47 mm) (adenoma vs cancer; 10mm, range (2-26) vs 13mm, range (1-47); pZ0.027), and the median procedure time was 42 minutes (adenoma vs cancer; 25min, range (8-128) vs 52.5min, range (23-165); pZ0.003). The en bloc resection rate was 90.2% (adenoma vs cancer; 93.5 % vs 86.7%; pZ0.031), Curative resection rate was 68.7% (adenoma vs cancer;87.1% vs 50.0%; pZ0.002). In non-curative resection cases of cancer group, horizontal margin positive was 7 cases, beyond indication were 7 cases, piecemeal resection was 4 cases, vertical margin positive was 3 cases. Adverse events included 2 cases of perforation (3.3%) and 2 cases of bleeding (3%) without emergent surgery. 5-year overall survival was 79.9% and 5-year disease free survival was 85.9% during a median follow-up period of 23.8 months (range 0.03-115.7 months), with no deaths from gastric cancer. All patients underwent regular endoscopy after subtotal gastrectomy during follow-up period. According to endoscopic surveillance interval (short [12 months] vs. long [>12 months]), there was a significant difference in proportion of histology (adenoma vs. adenocarcinoma, 12 months, 33.3% vs. 13.3%, >12 months, 66.7% vs. 86.7%, P Z 0.037). However, there was no difference of depth of the recurred adenocarcinoma and additional treatment modality (ESD or surgery) depends on endoscopy interval. Conclusions: ER for gastric neoplasm in the remnant stomach of patients after subtotal gastrectomy was a feasible and safe method. However, non-curative resection rate was higher in ER cases with EGC than adenoma, so careful decision for ER in patients with EGC after subtotal gastrectomy is required.
Mo1044 Comparison of Performance Characteristics of Endoluminal Bariatric Procedures between Gastroenterologists and Surgeons in the World: A Systematic Review and Meta-analysis Hongfeng Zhang* Department of Gastroenterology and Hepatology, University of Connecticut Health Center, West Hartford, CT Background: Endoluminal bariatric procedures are among the emerging techniques that are currently performed by both gastroenterologists and surgeons in the world. Endoscopic suturing and stapling techniques, despite their considerable limitations such as inadequate durability or threshold for treatment, have advantages including less pain, outpatient procedure, and a high level of patient acceptance. However, differences in performance of these techniques between gastroenterologists and
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB439