- Email: [email protected]
Mo1051 Endoscopic Resection of Large Colorectal Polyps in a UK Tertiary Referral Unit
Abstracts
inconclusive. Therefore, this study aimed to assess the diagnostic yield of CE in patients with unexplained IDA and to evaluate their long-term outcomes and related clinical factors. Methods: We analyzed data of 144 patients with unexplained IDA retrieved from the Capsule Endoscopy Nationwide Database Registry (CAPENTRY) in the Republic of Korea. IDA was defined as hemoglobin (Hb) < 13 g/dL in male and <11.5 g/dL in female. All patients underwent upper and lower endoscopy prior to CE and showed no bleeding foci in these exams. Patients’ demographics, past and medical histories, serologic tests, upper and lower endoscopic findings, CE findings, and clinical outcomes were evaluated by reviewing medical records. Results: The mean age at the initial diagnosis was 49.520.2 years (range 10-90 years) with male to female ratio of 1.03. Hb at CE and the lowest Hb for 3 months prior CE was 9.01.9 and 7.22.1 g/dL, respectively. The mean time interval from IDA diagnosis to CE examination was 6.924.0 months. Positive fecal occult blood test (FOBT) performed before CE was noted in 20.8% (30/144) patients. A total of 89 (61.8%) patients showed positive findings on CE, including angiodysplasia (23/16.0%), idiopathic ulcer (21/14.6%), mucosal erosion (17/11.8%), small bowel tumor (8/5.6%), small nonbleeding polyp or submucosal tumor (5/3.5%), and so on. During the mean follow-up period of 17.828.9 months, 7 overt and 3 occult bleeding developed. When analyzing clinical risk factors associated with rebleeding such as age at diagnosis, use of anti-platelet agents or FOBT prior to CE, CE features, and Hb level at CE, positive FOBT prior to CE was identified as a significant risk factor for subsequent rebleeding in patients with unexplained IDA. Conclusion: In this study, the overall diagnostic yield of CE is 61.8% in unexplained IDA. During follow-up, rebleeding develops in a considerable proportion of patients. Positive FOBT prior to CE is a meaningful risk factor for subsequent rebleeding in patients with unexplained IDA.
ESD (75 pts, 80 lesions) Adenocarcinoma Histology, no. (%) Well-differentiated Moderately-differentiated Median tumor size, mm (IQR) Depth, no. (%) Mucosa SM 1 Morphology, no. (%) Elevated Flat or depressed Ulceration Location, no. (%) Lower third Middle third Upper third Extended indication, no. (%) Residual lesion, no. (%)
Surgery (84 pts, 86 lesions)
37 (46.2)
66 (83.5)
56 (70.0) 24 (30.0) 9 (5-13)
49 (57.0) 37 (43.0) 15 (10-25)
75 (93.8) 5 (6.2)
71 (82.6) 15 (17.4)
13 (16.2) 67 (83.8) 13 (16.2)
14 (16.3) 72 (83.7) 15 (17.4)
69 10 1 42 1
49 34 3 56 0
P value .082
<0.001 .027
.996
(86.3) (12.5) (1.2) (52.5) (1.2)
(57.0) (39.5) (3.5) (65.1) (0)
.838 <0.001
.099 .482
*Only 79 results of pre-treatment histology could be found in surgery group. IQR, Interquartile range; SM 1, submucosal invasion less than 500mm.
Mo1050 Clinical Outcome of Endoscopic Submucosal Dissection Versus Surgery for Early Gastric Cancer; A Single Institute Experience in Korea Ji Young Chang*1, Ki-Nam Shim1, Chung Hyun Tae2, Hyo Moon Son1, Min Sun Ryu1, Chang Mo Moon1, Seong-Eun Kim1, Hye-Kyung Jung1, Sung-Ae Jung1, Sun Young Yi1, Ko Eun Lee1, Joo-Ho Lee3 1 Departments of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea (the Republic of); 2Health Promotion Medicine, Ewha Womans University School of Medicine, Seoul, Korea (the Republic of); 3Sugery, Ewha Womans University School of Medicine, Seoul, Korea (the Republic of) Aim: This study aimed to compare the clinicopathological characteristics and investigate whether long-term outcome of endoscopic submucosal dissection (ESD) are comparable with those of surgery for early gastric cancers (EGCs) that meet indications of absolute and extended ones. Methods: Data of 80 EGCs in 75 patients treated with ESD and 86 EGCs in 84 patients treated with surgery between January 2004 to October 2014 were analyzed retrospectively. We included the EGCs fulfilled the extended indications. EGCs that had lymphovascular invasion and lymph node metastasis and the cases that had less than one year follow-up period were excluded. Results: The median follow-up duration was 2 years (IQR 1-5 years) for ESD group and 4 years (IQR 2-6 years) for surgery group (P Z 0.010). The comorbidities were not significantly different between both groups. One patient (1.4%, P Z 0.465) in ESD group experienced local recurrence, but there was no metachronous tumor or metastasis in both groups. The 5-year overall survival rates were not different between ESD group and surgery group (92.8% vs 88.0%, respectively; P Z 0.223 by log-rank test). There was no gastric cancer related mortality during the follow-up period. Also, there was no significant difference in the 5-year disease-free survival rates between two groups (97.3% vs 96.9%; P Z 0.717). The rates of early complication which happened in 3 months of procedure were not significantly different between two groups (12.0% vs 6.0%, P Z 0.149). The late complication occurred only in surgery group (4.8%, P Z 0.078). All adverse events associated with ESD were managed by endoscopic and conservative treatment successfully. But, five patients needed additional surgical treatment in surgery group mainly due to wound leakage and incisional hernia. Conclusion: The long-term clinical outcomes after ESD were comparable to those of surgery for treatment of EGC based on absolute and extended indications. ESD could be more safe modality regarding the severity of adverse event.
Clinicopathological characteristics of the study population
Median age, year (IQR) Sex, no. (%) Male Female Pre-treatment histology, no. (%)* Adenoma
ESD (75 pts, 80 lesions)
Surgery (84 pts, 86 lesions)
65 (55.0-72.0)
63 (57.3-70.0)
54 (72.0) 21 (28.0)
46 (54.8) 38 (45.2)
43 (53.8)
13 (16.5)
P value .769 .025
<0.001
AB442 GASTROINTESTINAL ENDOSCOPY Volume 83, No. 5S : 2016
Comparison of 5-year disease-free survival (DFS) rates between endoscopic submucosal dissection (ESD) and surgery.
Mo1051 Endoscopic Resection of Large Colorectal Polyps in a UK Tertiary Referral Unit Andrew Emmanuel*1, Shraddha Gulati2, Bu Hayee2, Amyn Haji1 1 Colorectal Surgery, King’s College Hospital, London, United Kingdom; 2 Gastroenterology, King’s College Hospital, London, United Kingdom Introduction: Whilst the extensive experience of endoscopic resection of large colorectal polyps in Japan has resulted in clear and consistent indications for various techniques depending on polyp size and morphology, practice in western Europe is less well defined. We report the results of a prospective series of endoscopic resections using a variety of techniques from one of only a few tertiary referral centres in the UK providing advanced interventional endoscopy. The patients in this series present some unique challenges, for example the high proportion of patients referred with deeply scarred lesions after previous failed attempts at resection, and
www.giejournal.org
Abstracts
the large mean polyp size. Methods: A prospective series of colorectal endoscopic resections form a tertiary referral centre in the UK. Surveillance endoscopy was performed at 3 months and 12 months after resection. Results: 363 polyps with a mean size of 56mm were resected in 326 patients who had a mean age of 71 years: 309 by EMR, 38 by ESD and 16 by hybrid procedures involving ESD. The mean follow up was 12.2 months. Almost all patients were referred after their polyps were at least biopsied and 38% of polyps were deeply scarred from previous intervention. Despite this, adenoma recurrence occurred in only 9.7% of patients, 17% of which were diminutive. 6 patients with recurrence required surgery, 2 right hemicolectomies, 1 TEMS and 1 anterior resection and 2 declined surgery. 67% of patients with recurrence were treated successfully endoscopically with no further recurrence. Of those patients without invasive cancer at their first endoscopic resection, 95% were free from recurrence and had avoided surgery at last follow up. There was only one clinically significant perforation. 2 patients were admitted with post-procedure bleeding, one was managed conservatively and the other with endoscopic clips. Conclusion: These data demonstrate the effectiveness of a tertiary interventional endoscopy unit in a western setting in treating large and complex colorectal polyps, with low recurrence rates and very few significant complications. In contrast to practise in the east, more education is required to prevent multiple attempted interventions before referral to a highly specialised unit.
Mo1052 Inpatient Admissions After Bariatric Surgery: Analysis From the 2012 NIS Database Violeta Popov*2, Marwan S. Abougergi3, Christopher C. Thompson1 1 Division of Gastroenterology, Brigham & Women’s Hospital, Boston, MA; 2NYU Medical Center, New York, NY; 3Catalyst Medical Consulting, Baltimore, MD Background: Bariatric surgery has been shown to improve or reverse many obesityrelated comorbidities. More than 200,000 procedures are performed annually. Concerns remain about long –term complications and patient outcomes. Analysis of factors associated with complications requires a large number of cases, which are usually not available in single center studies. Aim: To assess the rates and primary diagnoses for hospital admissions in patients who have had prior bariatric surgery compared to hospital admissions after other common digestive surgeries (cholecystectomy and intestinal resection). Methods: We analyzed discharge data on patients with history of bariatric surgery who had a hospital admission in 2012 using the Nationwide Inpatient Sample (NIS) database. We compared it to inpatient admissions in 2012 of patients with history of cholecystectomy (CCY) and intestinal resection. To confirm consistency of results, a comparison was made with admissions in post-bariatric patients in 2011. The primary outcome was the most common admission diagnoses and rate. Secondary outcomes included analysis of admissions for known long-term weight loss surgery complications, demographic and medical characteristics of the patients. Results: In 2012, there were 249, 565 hospital admissions in patients with history of bariatric surgery; 370, 910 admissions for patients with history of CCY; and 162, 910 admissions for patients with history of bowel resection. To compare, there were 57, 645 new bypass surgeries and 401, 120 CCY procedures performed in 2012. The most common admission diagnoses and frequencies are presented in Figure 1; there was no difference between the 2012 and 2011 admissions. Post-bariatric patients were more commonly admitted for osteoarthritis, intestinal obstruction, post-operative infections, adhesions, incarcerated hernia, cellulitis, marginal ulcers than patients with history of CCY (P<0.005). Patients with bariatric surgery were admitted less often for pneumonia, sepsis, acute pancreatitis, coronary artery disease, heart failure, bronchitis, urinary infection and diverticulitis than patients with CCY or intestinal resection. Additionally, patients with history of bariatric surgery were more commonly admitted for alcohol addiction, anemia, anorexia, bulimia, dumping syndrome (Table 1). They were more likely to be younger and have private insurance. Conclusion: Patients with history of bariatric surgery had an unexpectedly higher frequency of admissions for knee osteoarthritis in this generally younger population, and increased rates of admissions for cellulitis and alcohol abuse, compared to patients with history of other digestive surgeries. Further studies are needed to evaluate the effect of obesity, modifiable risk factors. Table 1. Secondary outcomes. Socio-demographic characteristics of the patients and medical admissions due to other common conditions or complications
Demographic Factors
Average, Hx of bariatric surgery
Average, Hx of CCY
Average, Hx of int. resection
Age, yrs
52
61
65
% Female Smoke (%) Alcohol (%)
80 14 5.5
67 17 8
54 13 3
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Medical admissions Anemia CHF Cancer Anorexia Bulimia Dumping Alcohol Abuse
Insurance (%) -Medicare -Medicaid -Private Zip Code (%) <40K 40-48K 48-63K >63K LOS, days OR, Hx of CCY 0.7 1.9 3 0.3 0.1 0.1 0.65
Average, Hx of bariatric surgery
Average, Hx of CCY
Average, Hx of int. resection
34 11 46
53 11 27
60 8 26
25 25 26 22 4.2 95% CI
30 25 25 20 4.3 OR, Hx of int. resection 0.8 1.9 8 0.7 0.05 0.3 0.53
25 24 25 25 5 95% CI
0.6, 0.7 1.8, 2 2.7,3.3 0.2,0.7 0.06,0.3 0.09,0.2 0.6,0.7
0.7,0.9 1, 8.2 7, 8.6 0.3, 1.4 0.07, 0.4 0.2, 0.5 0.5, 0.6
Figure 1. Frequencies of most common admission in 2012 for patients with History of bariatric surgery, cholecystectomy, intestinal resection, and History of bariatric surgery in 2011.
Mo1053 Feeding Tube Placement: Do We Need to Take It Down a PEG? Identifying Risk Factors for Adverse Outcomes After PEG Tube Placement Varun Kapur*1, Mohammed I. Ali2, Daniel Hassumani2, Elango Edhayan1, Karen Hagglund1, Jeanne Lewandowski1 1 Surgery, St John Hospital, Saint Clair Shores, MI; 2medical School, St. Georges University, St George, Grenada Background: Percutaneous Endoscopic Gastrostomy (PEG) tube placement is done for long term enteral nutritional support. Procedure-related mortality has been reported to be about 0.5%; however, there is a reported 30-day all-cause mortality of 15-25%. Often, critically ill and frail patients are referred for PEG placement with no expected improvement in quality of life. Current guidelines recommend PEG placement when life expectancy is greater than 4 weeks, with consideration given to quality of life and prospects for recovery. Peri-operative mortality from PEG placement is not studied as a quality marker by major quality and outcomes databases such as () NSQIP. We aimed to study risk factors associated with 30 day mortality after PEG placement including ()MFI (Table 1), renal failure requiring dialysis and admission to the Critical Care unit. Methods: We retrospectively studied a cohort of patients who had a PEG placement at our hospital from May 2012 to June 2013. We excluded patients who had a prior PEG tube placement or if it had been placed for non-nutritional reasons. We collected data on demographics and factors included in the MFI. Our primary outcome measure was 30-day mortality. We correlated MFI with mortality using unpaired two tailed t-test. We performed univariate analysis of
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB443
inconclusive. Therefore, this study aimed to assess the diagnostic yield of CE in patients with unexplained IDA and to evaluate their long-term outcomes and related clinical factors. Methods: We analyzed data of 144 patients with unexplained IDA retrieved from the Capsule Endoscopy Nationwide Database Registry (CAPENTRY) in the Republic of Korea. IDA was defined as hemoglobin (Hb) < 13 g/dL in male and <11.5 g/dL in female. All patients underwent upper and lower endoscopy prior to CE and showed no bleeding foci in these exams. Patients’ demographics, past and medical histories, serologic tests, upper and lower endoscopic findings, CE findings, and clinical outcomes were evaluated by reviewing medical records. Results: The mean age at the initial diagnosis was 49.520.2 years (range 10-90 years) with male to female ratio of 1.03. Hb at CE and the lowest Hb for 3 months prior CE was 9.01.9 and 7.22.1 g/dL, respectively. The mean time interval from IDA diagnosis to CE examination was 6.924.0 months. Positive fecal occult blood test (FOBT) performed before CE was noted in 20.8% (30/144) patients. A total of 89 (61.8%) patients showed positive findings on CE, including angiodysplasia (23/16.0%), idiopathic ulcer (21/14.6%), mucosal erosion (17/11.8%), small bowel tumor (8/5.6%), small nonbleeding polyp or submucosal tumor (5/3.5%), and so on. During the mean follow-up period of 17.828.9 months, 7 overt and 3 occult bleeding developed. When analyzing clinical risk factors associated with rebleeding such as age at diagnosis, use of anti-platelet agents or FOBT prior to CE, CE features, and Hb level at CE, positive FOBT prior to CE was identified as a significant risk factor for subsequent rebleeding in patients with unexplained IDA. Conclusion: In this study, the overall diagnostic yield of CE is 61.8% in unexplained IDA. During follow-up, rebleeding develops in a considerable proportion of patients. Positive FOBT prior to CE is a meaningful risk factor for subsequent rebleeding in patients with unexplained IDA.
ESD (75 pts, 80 lesions) Adenocarcinoma Histology, no. (%) Well-differentiated Moderately-differentiated Median tumor size, mm (IQR) Depth, no. (%) Mucosa SM 1 Morphology, no. (%) Elevated Flat or depressed Ulceration Location, no. (%) Lower third Middle third Upper third Extended indication, no. (%) Residual lesion, no. (%)
Surgery (84 pts, 86 lesions)
37 (46.2)
66 (83.5)
56 (70.0) 24 (30.0) 9 (5-13)
49 (57.0) 37 (43.0) 15 (10-25)
75 (93.8) 5 (6.2)
71 (82.6) 15 (17.4)
13 (16.2) 67 (83.8) 13 (16.2)
14 (16.3) 72 (83.7) 15 (17.4)
69 10 1 42 1
49 34 3 56 0
P value .082
<0.001 .027
.996
(86.3) (12.5) (1.2) (52.5) (1.2)
(57.0) (39.5) (3.5) (65.1) (0)
.838 <0.001
.099 .482
*Only 79 results of pre-treatment histology could be found in surgery group. IQR, Interquartile range; SM 1, submucosal invasion less than 500mm.
Mo1050 Clinical Outcome of Endoscopic Submucosal Dissection Versus Surgery for Early Gastric Cancer; A Single Institute Experience in Korea Ji Young Chang*1, Ki-Nam Shim1, Chung Hyun Tae2, Hyo Moon Son1, Min Sun Ryu1, Chang Mo Moon1, Seong-Eun Kim1, Hye-Kyung Jung1, Sung-Ae Jung1, Sun Young Yi1, Ko Eun Lee1, Joo-Ho Lee3 1 Departments of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea (the Republic of); 2Health Promotion Medicine, Ewha Womans University School of Medicine, Seoul, Korea (the Republic of); 3Sugery, Ewha Womans University School of Medicine, Seoul, Korea (the Republic of) Aim: This study aimed to compare the clinicopathological characteristics and investigate whether long-term outcome of endoscopic submucosal dissection (ESD) are comparable with those of surgery for early gastric cancers (EGCs) that meet indications of absolute and extended ones. Methods: Data of 80 EGCs in 75 patients treated with ESD and 86 EGCs in 84 patients treated with surgery between January 2004 to October 2014 were analyzed retrospectively. We included the EGCs fulfilled the extended indications. EGCs that had lymphovascular invasion and lymph node metastasis and the cases that had less than one year follow-up period were excluded. Results: The median follow-up duration was 2 years (IQR 1-5 years) for ESD group and 4 years (IQR 2-6 years) for surgery group (P Z 0.010). The comorbidities were not significantly different between both groups. One patient (1.4%, P Z 0.465) in ESD group experienced local recurrence, but there was no metachronous tumor or metastasis in both groups. The 5-year overall survival rates were not different between ESD group and surgery group (92.8% vs 88.0%, respectively; P Z 0.223 by log-rank test). There was no gastric cancer related mortality during the follow-up period. Also, there was no significant difference in the 5-year disease-free survival rates between two groups (97.3% vs 96.9%; P Z 0.717). The rates of early complication which happened in 3 months of procedure were not significantly different between two groups (12.0% vs 6.0%, P Z 0.149). The late complication occurred only in surgery group (4.8%, P Z 0.078). All adverse events associated with ESD were managed by endoscopic and conservative treatment successfully. But, five patients needed additional surgical treatment in surgery group mainly due to wound leakage and incisional hernia. Conclusion: The long-term clinical outcomes after ESD were comparable to those of surgery for treatment of EGC based on absolute and extended indications. ESD could be more safe modality regarding the severity of adverse event.
Clinicopathological characteristics of the study population
Median age, year (IQR) Sex, no. (%) Male Female Pre-treatment histology, no. (%)* Adenoma
ESD (75 pts, 80 lesions)
Surgery (84 pts, 86 lesions)
65 (55.0-72.0)
63 (57.3-70.0)
54 (72.0) 21 (28.0)
46 (54.8) 38 (45.2)
43 (53.8)
13 (16.5)
P value .769 .025
<0.001
AB442 GASTROINTESTINAL ENDOSCOPY Volume 83, No. 5S : 2016
Comparison of 5-year disease-free survival (DFS) rates between endoscopic submucosal dissection (ESD) and surgery.
Mo1051 Endoscopic Resection of Large Colorectal Polyps in a UK Tertiary Referral Unit Andrew Emmanuel*1, Shraddha Gulati2, Bu Hayee2, Amyn Haji1 1 Colorectal Surgery, King’s College Hospital, London, United Kingdom; 2 Gastroenterology, King’s College Hospital, London, United Kingdom Introduction: Whilst the extensive experience of endoscopic resection of large colorectal polyps in Japan has resulted in clear and consistent indications for various techniques depending on polyp size and morphology, practice in western Europe is less well defined. We report the results of a prospective series of endoscopic resections using a variety of techniques from one of only a few tertiary referral centres in the UK providing advanced interventional endoscopy. The patients in this series present some unique challenges, for example the high proportion of patients referred with deeply scarred lesions after previous failed attempts at resection, and
www.giejournal.org
Abstracts
the large mean polyp size. Methods: A prospective series of colorectal endoscopic resections form a tertiary referral centre in the UK. Surveillance endoscopy was performed at 3 months and 12 months after resection. Results: 363 polyps with a mean size of 56mm were resected in 326 patients who had a mean age of 71 years: 309 by EMR, 38 by ESD and 16 by hybrid procedures involving ESD. The mean follow up was 12.2 months. Almost all patients were referred after their polyps were at least biopsied and 38% of polyps were deeply scarred from previous intervention. Despite this, adenoma recurrence occurred in only 9.7% of patients, 17% of which were diminutive. 6 patients with recurrence required surgery, 2 right hemicolectomies, 1 TEMS and 1 anterior resection and 2 declined surgery. 67% of patients with recurrence were treated successfully endoscopically with no further recurrence. Of those patients without invasive cancer at their first endoscopic resection, 95% were free from recurrence and had avoided surgery at last follow up. There was only one clinically significant perforation. 2 patients were admitted with post-procedure bleeding, one was managed conservatively and the other with endoscopic clips. Conclusion: These data demonstrate the effectiveness of a tertiary interventional endoscopy unit in a western setting in treating large and complex colorectal polyps, with low recurrence rates and very few significant complications. In contrast to practise in the east, more education is required to prevent multiple attempted interventions before referral to a highly specialised unit.
Mo1052 Inpatient Admissions After Bariatric Surgery: Analysis From the 2012 NIS Database Violeta Popov*2, Marwan S. Abougergi3, Christopher C. Thompson1 1 Division of Gastroenterology, Brigham & Women’s Hospital, Boston, MA; 2NYU Medical Center, New York, NY; 3Catalyst Medical Consulting, Baltimore, MD Background: Bariatric surgery has been shown to improve or reverse many obesityrelated comorbidities. More than 200,000 procedures are performed annually. Concerns remain about long –term complications and patient outcomes. Analysis of factors associated with complications requires a large number of cases, which are usually not available in single center studies. Aim: To assess the rates and primary diagnoses for hospital admissions in patients who have had prior bariatric surgery compared to hospital admissions after other common digestive surgeries (cholecystectomy and intestinal resection). Methods: We analyzed discharge data on patients with history of bariatric surgery who had a hospital admission in 2012 using the Nationwide Inpatient Sample (NIS) database. We compared it to inpatient admissions in 2012 of patients with history of cholecystectomy (CCY) and intestinal resection. To confirm consistency of results, a comparison was made with admissions in post-bariatric patients in 2011. The primary outcome was the most common admission diagnoses and rate. Secondary outcomes included analysis of admissions for known long-term weight loss surgery complications, demographic and medical characteristics of the patients. Results: In 2012, there were 249, 565 hospital admissions in patients with history of bariatric surgery; 370, 910 admissions for patients with history of CCY; and 162, 910 admissions for patients with history of bowel resection. To compare, there were 57, 645 new bypass surgeries and 401, 120 CCY procedures performed in 2012. The most common admission diagnoses and frequencies are presented in Figure 1; there was no difference between the 2012 and 2011 admissions. Post-bariatric patients were more commonly admitted for osteoarthritis, intestinal obstruction, post-operative infections, adhesions, incarcerated hernia, cellulitis, marginal ulcers than patients with history of CCY (P<0.005). Patients with bariatric surgery were admitted less often for pneumonia, sepsis, acute pancreatitis, coronary artery disease, heart failure, bronchitis, urinary infection and diverticulitis than patients with CCY or intestinal resection. Additionally, patients with history of bariatric surgery were more commonly admitted for alcohol addiction, anemia, anorexia, bulimia, dumping syndrome (Table 1). They were more likely to be younger and have private insurance. Conclusion: Patients with history of bariatric surgery had an unexpectedly higher frequency of admissions for knee osteoarthritis in this generally younger population, and increased rates of admissions for cellulitis and alcohol abuse, compared to patients with history of other digestive surgeries. Further studies are needed to evaluate the effect of obesity, modifiable risk factors. Table 1. Secondary outcomes. Socio-demographic characteristics of the patients and medical admissions due to other common conditions or complications
Demographic Factors
Average, Hx of bariatric surgery
Average, Hx of CCY
Average, Hx of int. resection
Age, yrs
52
61
65
% Female Smoke (%) Alcohol (%)
80 14 5.5
67 17 8
54 13 3
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Medical admissions Anemia CHF Cancer Anorexia Bulimia Dumping Alcohol Abuse
Insurance (%) -Medicare -Medicaid -Private Zip Code (%) <40K 40-48K 48-63K >63K LOS, days OR, Hx of CCY 0.7 1.9 3 0.3 0.1 0.1 0.65
Average, Hx of bariatric surgery
Average, Hx of CCY
Average, Hx of int. resection
34 11 46
53 11 27
60 8 26
25 25 26 22 4.2 95% CI
30 25 25 20 4.3 OR, Hx of int. resection 0.8 1.9 8 0.7 0.05 0.3 0.53
25 24 25 25 5 95% CI
0.6, 0.7 1.8, 2 2.7,3.3 0.2,0.7 0.06,0.3 0.09,0.2 0.6,0.7
0.7,0.9 1, 8.2 7, 8.6 0.3, 1.4 0.07, 0.4 0.2, 0.5 0.5, 0.6
Figure 1. Frequencies of most common admission in 2012 for patients with History of bariatric surgery, cholecystectomy, intestinal resection, and History of bariatric surgery in 2011.
Mo1053 Feeding Tube Placement: Do We Need to Take It Down a PEG? Identifying Risk Factors for Adverse Outcomes After PEG Tube Placement Varun Kapur*1, Mohammed I. Ali2, Daniel Hassumani2, Elango Edhayan1, Karen Hagglund1, Jeanne Lewandowski1 1 Surgery, St John Hospital, Saint Clair Shores, MI; 2medical School, St. Georges University, St George, Grenada Background: Percutaneous Endoscopic Gastrostomy (PEG) tube placement is done for long term enteral nutritional support. Procedure-related mortality has been reported to be about 0.5%; however, there is a reported 30-day all-cause mortality of 15-25%. Often, critically ill and frail patients are referred for PEG placement with no expected improvement in quality of life. Current guidelines recommend PEG placement when life expectancy is greater than 4 weeks, with consideration given to quality of life and prospects for recovery. Peri-operative mortality from PEG placement is not studied as a quality marker by major quality and outcomes databases such as () NSQIP. We aimed to study risk factors associated with 30 day mortality after PEG placement including ()MFI (Table 1), renal failure requiring dialysis and admission to the Critical Care unit. Methods: We retrospectively studied a cohort of patients who had a PEG placement at our hospital from May 2012 to June 2013. We excluded patients who had a prior PEG tube placement or if it had been placed for non-nutritional reasons. We collected data on demographics and factors included in the MFI. Our primary outcome measure was 30-day mortality. We correlated MFI with mortality using unpaired two tailed t-test. We performed univariate analysis of
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB443