- Email: [email protected]
Mo1246 Colonoscopy Withdrawal Times and Adenoma Detection During Screening Colonoscopy
Abstracts
17(38%), and C in 6(13%). The aetiology of liver disease was hepatitis B, hepatitis C, alcohol, and other causes in 7(16%), 26(57%), 5(11%), and 7(16%), respectively. The causes of biliary obstruction were classified as: bile duct stones: 18(40%), hemobilia: 4(9%) and malignant disease: 23(51%). Bile duct clearance was achieved in all the cases of stones. No serious early complications were observed. However, one patient undergoing hemodialysis had delayed biliary hemorrhage one week after the procedure and died from liver failure after two months. All patients with hemobilia were uneventfully cured by removing hematoma endoscopically. In 23 patients with malignant obstructive jaundice, hepatocellular carcinoma was detected in 16 patients, carcinoma of gallbladder in 2, bile duct carcinoma in 2, and pancreatic carcinoma in 3. There were 17 cases of hilar bile duct obstruction and 6 cases of extrahepatic biliary obstruction. An appropriate endoscopic biliary drainage procedure was successfully perfomed in all cases with no serious complication. An effective biliary drainage was achieved in 18 cases (78%). However, in 5 patients (22%), jaundice could not be improved and all those patients died within a few weeks. The risk factors for ineffective biliary drainage were hilar bile duct obstruction. Conclusion: Even in patients with liver cirrhosis, endoscopic procedures, to bile duct stones and hemobilia, can be safely and effectively carried out. On the other hand, we need a careful consideration to perform endoscopic drainage to malignant obstructive jaundice, especially in the cases of hilar bile duct obstruction.
Mo1244 Patterns of Split Dosing Recommendations for Colonoscopy Bowel Preparation: Results of a National Survey Grace Clarke Hillyer1, Benjamin Lebwohl*2,3, Corey Basch4, Charles Basch5, Fay Kastrinos2,3, Beverly J. Insel1, Alfred I. Neugut1,6 1 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; 2Division of Digestive and Liver Diseases, College of Physicians and Surgeons of Columbia University, New York, NY; 3Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons of Columbia University, New York, NY; 4 Department of Public Health, William Paterson University, Paterson, NJ; 5Department of Health and Behavior Studies, Teachers College of Columbia University, New York, NY; 6Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, NY Background: Rates of colorectal cancer have declined over the past 2 decades and have been attributed to increased rates of colorectal cancer screening, particularly colonoscopy. As a result, newer methods of improving bowel preparation quality have become increasingly important. Split dosing of the purgative has been consistently shown to improve bowel preparation quality, but little is known about the extent of its use in clinical practice. As part of a larger study to assess the relationship between self-reported proportion of suboptimal bowel preparations and bowel preparation recommendations, we sought to describe utilization of purgative split dosing as preparation for colonoscopy among gastroenterologists in the U.S. Methods: A randomly selected sample of the membership of a national professional organization of gastroenterologists was sent a web-based or postal survey between September 2010 and March 2011. Participants were queried about sociodemographic information, practice characteristics, and use of purgative split dosing. Comparisons were made between those participants who did and did not recommend split dosing and other covariates. Categorical data was analyzed using Pearson’s Chi square test of association. Results: A total of 1,355 physicians were invited to participate where 999 were eligible; 288 (29%) responded to the survey and 283 answered the question regarding split dosing. 60% of respondents indicated that they recommend split dosing; those using split-dose preparations had mean age of 50 years, were mostly white (62%), male (61%), and specified GI certification/ specialty (63%). Most practiced in urban settings (60%), had a private practice (64%), were affiliated with a non-teaching hospital (68%), and performed ⬎30 colonoscopies per week (71%). Split dosing of the purgative was associated with older age (⬎48 years) (67.2% vs. 53.2% for younger age, p ⫽ 0.02), private vs. hospital/university practice types (63.8% vs. 50.5%, p ⫽ 0.03), and non-teaching hospital affiliation (68.0% vs. 55.1%, p ⫽ 0.03). Conclusions: Our findings indicate that 60% of respondents utilize split dosing of purgative prior to colonoscopy. As split dosing is considered to be a key measure to improve the quality and cost-effectiveness of colonoscopy, this finding is encouraging. Surprisingly, older physicians, those in private practice, and those with nonteaching hospital affiliation were more likely to have adopted split dosing. Continuing medical education to increase utilization of the split dose purgative method is warranted.
Mo1245 Clinical Outcomes and Complications of Histoacryl Injection for Gastric Variceal Hemorrhage; What are the Determining Factors? Tanyaporn Chantarojanasiri*, Varayu Prachayakul, Pitulak Aswakul, Udom Kachintorn Gastroenterology, Siriraj Hospital, Bangkok, Thailand Background: Gastric variceal hemorrhage is an uncommon cause of upper gastrointestinal bleeding, mostly related to portal hypertension, however it associates with very high mortality and morbidity. Histoacryl injection had been reported to be effective haemostatic method, but it has several drawbacks due to complications. Up to the present, there was limited data regarding of the factors determining the clinical outcomes and complications. Aim: The aim of this study was to determine the factors associated with clinical outcomes and complications of histoacryl injection for gastric variceal hemorrhage. Materials and Methods: We conducted a retrospective review of the data of the adults who underwent Histoacryl Injection for Gastric Variceal Hemorrhage from April, 2008 to October 2011. The baseline characteristics, endoscopic finding, clinical characteristics, clinical outcomes and complications were analyzed. Results: A total of 88 procedures was enrolled, mean age 55.5 ⫾ 13.6 (15-88) years old, 73% of whom were male, the most common presentation were hemetemesis, melena and coffee ground emesis for 69.7%, 13.5% and 9.0% respectively. Initial haemostasis was 96.6% while re-bleeding in 120 hours was 10.1%. Early complications was 14.6% mainly from non fatal systemic embolizations(41.6%). The factors associated with complications were poor liver status, emergency endoscopy, concurrent hepatocellular carcinoma and larger amount of blood transfusion. Mortality rate was 21.3%, mostly related to infection. The factors associated with higher mortality were poor liver status, longer hospital stay, larger amount blood transfusion, longer duration of intravenous vasoactive agent and larger amount of injected histoacryl. Conclusion: Histoacryl injection for Gastric Variceal Hemorrhage was an excellent haemostatic methods with 14.6% of early complications. The clinical outcomes were mostly associated with clinical status of the patients more than the therapeutic procedure itself.
Mo1246 Colonoscopy Withdrawal Times and Adenoma Detection During Screening Colonoscopy Sandra Canseco, David Diaz, Carolina Bolino, Cecilio L. Cerisoli*, Luis E. Caro Gedyt, Buenos Aires, Argentina Introduction: Colonoscopy is widely recommended as the best method for Colorectal Cancer (CRC) screening. Being performed within ASGE quality indicators for colonoscopy these procedures are effective, safe and well tolerated. The U.S. Multi-Society Task Force and ASGE estimate that Adenomas Detection Rate (ADR) in asymptomatic healthy subjects ⱖ50 years should be 25% in men and 15% in women. According to experts, 6 minutes is the minimum length of time to allow adequate inspection during instrument withdrawal. Objective: To estimate if ADR is different in colonoscopy withdrawal time of ⬍ 6 minutes with the rate of those who had mean withdrawal time ⱖ 6 minutes. Materials and Methods: CRC average-risk adult population was included. Risk factors for CRC and adenomas, incomplete colonoscopies and colorectal surgeries were exclusion criteria. The study was carried out in an endoscopy center in Buenos Aires, Argentine, between August 2010 and August 2011. The study design was prospective, comparative, and observational and cross sectional. Colonoscopies were performed by 11 operators under sedation, administered by anesthesiologists. Polietilenglicol (PEG) with and without bisacodyl was used for cleansing. Polyps were resected with forceps, snare or Endoscopic Mucosal Resection (EMR). Histological assessment was done by three experienced pathologists in gastrointestinal tract. The protocol was approved by IRB. Statistical analysis: SPSS V16; 95% CI estimation, Chi Square, Fisher, Student test, Kolmogorov-Smirnov test, ANOVA, and Bonferroni test were used. Results: 594 patients were enrolled. Sample size characteristics are summarized in table 1. 1. ADR was 23.4% in the group of ⬍6 minutes (G1) vs. 21.8% in the group ⱖ 6 minutes (G2), (p⫽0.725). The analysis of the number of adenomas showed that higher percentage of patients with 2 or 3 adenomas were found in G2; this difference was statistically significant (p ⫽ 0.003). The differences between average withdrawal time according to number of adenomas were statistically significant (p ⬍0.001). Age, gender, time of day for performing the procedure and cleansing preparation were evaluated as possible factors for this finding. It was observed that patients with ⱖ 2 adenomas were significantly older than patients with at least 1 adenoma (p ⫽ 0.047). Conclusions: In our series no difference in ADT was found in different withdrawal times; however the number of adenomas detected in the procedures was higher in older patients who had colonoscopies with withdrawal time ⱖ 6 minutes. Future studies are needed to explain this finding. Table 1. Sample size characteristics
AB363 GASTROINTESTINAL ENDOSCOPY Volume 75, No. 4S : 2012
www.giejournal.org
Abstracts
Age (average) Females Males Total
Withdrawal time < 6 minutes (G1)
Withdrawal time > 6 minutes (G2)
54, 82 55,8% (n:155) 44.2% (n:123) 100% (n:278)
58, 22 54,7% (n:173) 45,3% (n:143) 100% (n:316)
Mo1247 Diagnosis of Laryngeal and Hypopharyngeal Diseases Can Be Done During Routine Upper Endoscopy Petr Vitek*1,3, Ivana Mikoviny Kajzrlikova1, Martin Hanousek2, Ondrej Urban2,3, Karol Zelenik4, Josef Chalupa1, Pavel Kominek4 1 Internal Medicine Department, Beskydy Gastrocentre, Frydek-Mistek, Czech Republic; 2Gastroenterology, Hospital Vitkovice, Ostrava, Czech Republic; 3Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic; 4Clinic of Otorhinolaryngology, University Hospital Ostrava, Ostrava, Czech Republic Introduction: Laryngeal and hypopharyngeal neoplastic and non-neoplastic diseases are frequently diagnosed at advanced stage. We have decided to evaluate ability of laryngeal and hypopharyngeal photography (LHP) performed during routine esophagogastroduodenoscopy (EGD) for diagnosis of laryngeal and hypopharyngeal diseases. Methods: In this pilot prospective bicentral study three standard LHPs (larynx, right and left piriform sinus) were recorded during all EGD performed during the study period of 1-9/2011. Epidemiologic data via questionnaire were obtained. LHPs were subsequently independently evaluated for presence of neoplastic and non-neoplastic lesions by gastroenterologist (GE) and otorhinolaryngologist (ORL) and clinical laryngeal and hypopharyngeal examination was performed if indicated by ORL. Inclusion criteria were age 1880 years and informed consent of patient. Odds ratios (ORs) and 95% confidence intervals (CI) were used to describe the associations. Results: Total number of 1224 patients (males 629, females 595, mean age 56 (SD ⫾ 15,8) years) were included. 35 (3%) patients were excluded from analysis because of low quality of LHPs. Based on LHPs, GE suspected patology in 5, 3% (64/1189) and ORL suspected patology in 58, 5% (696/1189) of patients. Clinical examination was indicated by ORL in 58 (4, 9%) of patients. The most frequent finding was reflux laryngitis in 653 (54,9%) patients. Laryngeal spinocellular carcinoma was found and histologically confirmed in 3 (0,3%) patients (all three males, mean age 60 years, all recognized both by GE and ORL), benign lesion in 56 (4, 7%) patients. There were no significant associations of reflux laryngitis in the bivariate analysis for age, sex, body mass index, presence of endoscopic esofagitis, smoking, alcohol, dysphagia, heartburn, hoarseness, diabetes and asthma. Conclusion: Laryngeal and hypopharyngeal photography were feasible in 97% of patients coming to routine EGD. We have found pathology in almost 60% of patients. The most frequent finding was reflux laryngitis, however we have also found 3 (0, 3%) laryngeal cancers. We have found no statistically significant association between reflux laryngitis and reflux esophagitis or reflux symptoms. We conclude that routine endoscopic examination of laryngeal and hypopharyngeal region during esophagogastroduodenoscopy could be beneficial for the patient.
Mo1248 Computer Based Virtual Reality Colonoscopy Simulation Improves Patient Based Colonoscopy Performance Keith S. Mcintosh*, Nitin V. Khanna, James C. Gregor Division of Gastroenterology, University of Western Ontario, London, ON, Canada Aims: The advancement of computer technology has led to the development of several virtual reality colonoscopy simulators. The potential benefits as a training tool include the ability to do an unlimited number of procedures with no risk of procedural related complications. Our aim in this study is to determine whether virtual reality simulator training translates into improved patient based colonoscopy performance. Methods: We enrolled 18 residents between PGY2 and PGY4 with no prior colonoscopy experience. They were assigned to be in either the simulator trained group (n ⫽ 10) or the non-simulator trained control group (n⫽8). The simulator group completed an average of 16 hours (range 12 20) on the Simbionix GI Mentor II colonoscopy simulator prior to patient based colonoscopy. We then evaluated both groups on their first 5 patient based colonoscopies, giving the residents a 15 minute time limit to reach the cecum. Objective: Outcome measures included the insertion time, depth of insertion and the number of assists required. Preset criteria for assisting fellows included making no forward progress with the scope over a period of 2 minutes. Subjective outcome measures included ratings of pain, attention to discomfort, and technique by the proctor, endoscopy nurse, and patient on a 5 point Likert scale. Results: Within the allotted time, the average distance reached was the hepatic flexure by the simulator group and the transverse colon by the controls (p⫽0.09). The simulator group required significantly less assists than the control
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group (1.94 vs. 3.43, p⫽⬍0.001), inserted the scope further unassisted (43cm vs. 24cm, p⫽0.003), and there was a trend to reach the cecum more often (26% vs. 10%, p⫽0.06). The simulator group received higher ratings of competence by both the proctors (2.28 vs. 1.88 out of 5, p⫽0.02) and the endoscopy nurses (2.56 vs. 2.05 out of 5, p⫽0.001). There were no significant differences in proctor, nurse or patient rated pain or attention to discomfort. Conclusions: In the initial stages of training, patient based colonoscopy performance is superior in simulator trained residents compared to non-simulator trained residents. The residents completing simulator training were all highly satisfied with the experience and this study indicates that at least 16 hours of training may be required for optimal benefit. As well, the method of providing “assists” to residents for challenging parts of the colonoscopy and returning the scope to them worked extremely well. Employing this technique, allowed the novice residents to perform successful and efficient colonoscopies with a high degree of patient satisfaction.
Mo1249 Gender Preference for Endoscopists Among US Muslims: A Population and Acculturation Based Survey Sabeen Abid*, Nandhakumar Kanagarajan, Scott Naples, Asyia S. Ahmad Medicine, Drexel University College of Medicine, Philadelphia, PA Background: Gender preference for endoscopist has been cited as being as high as 43% in women and 21% in men in a diverse US population. Factors that have shown to predict gender preference for endoscopist include gender, socioeconomic status and history of abuse. No study to date has looked at gender preference for endoscopist in a specific religious group. Objective: The aim of this study was to determine the gender preference for endoscopist in Muslims living in the US. Methods: Adult Muslims from three community centers completed a questionnaire that included patient demographics, country of origin, length of stay in US, income level, education level and gender preferences toward various health-care professionals including endoscopists. The validated Vancouver Index of Acculturation (VIA) survey was also administered in order to determine level of acculturation. Scores indicated if subjects predominantly associated themselves with people from their country of origin (heritage) or with Americans (mainstream). Results: There were 159 Muslims that completed the questionnaire of which 91(57%) were men and 68 (43%) were women. Gender preference for endoscopist in our Muslim population was 65.4%. Muslim women had a significantly higher gender preference for endoscopist as compared to Muslim men (82.3% vs. 52.7%; P value ⬍ 0.0001). One hundred percent of women and 94.4% of men with a gender preference expressed preference for an endoscopist of the same gender. Marital status, age, educational level, and socioeconomic status did not have a significant influence on gender preference for endoscopist. Muslims who lived in the US for ⬎10 years tended to have a higher gender preference for endoscopist as compared to those who did not (68.9% vs. 51%; P value⫽NS). Analysis of VIA score showed that 67.9% of Muslims had a high heritage score, 18.8% had a high mainstream score and 15% had both a high mainstream and a high heritage score. Women tended to have a high heritage score as compared to men (72% vs. 64.8%; P value⫽NS). Muslims with a high heritage score tended to have a gender preference as compared to those with a high mainstream score (66% vs. 53%; P value ⫽ NS). Women with a high heritage score were more likely to have a gender preference as compared to men with a high heritage score (85.7% vs. 50.8%; P value ⬍0.0002). Conclusion: Our study is the first to evaluate gender preference for endoscopist in the growing US Muslim population. Both Muslim men and women have a strikingly high gender preference for endoscopist. Muslim women who predominantly associate themselves with their heritage almost always prefer to have a woman perform their endoscopic procedures. Physician’s awareness of high gender preference rates in Muslims is crucial in improving patient comfort and compliance with endoscopic procedures in this population.
Mo1250 Is Endoscopic Mucosal Resection a Sufficient Treatment for Low-Grade Gastric Epithelial Dysplasia? Seul Young Kim*, Hyun Yong Jeong, Byung Seok Lee, Jaekyu Sung, Hee Seok Moon Chung Nam University Chung Nam University College of Medicine, Daejeon, Republic of Korea Purpose: Gastric adenoma with high-grade dysplasia (HGD) is an obvious precancerous lesion and needs aggressive treatment, such as surgery or endoscopic submucosal dissection(ESD). However, the natural history of lowgrade dysplasia (LGD)varies, and there is no treatment guideline for LGD. This study was performed to evaluate the risk factors for the progression of LGD to HGD or early gastric cancer (EGC) after endoscopic treatment. To determine the appropriate treatment for LGD,we compared the rates of complication, recurrence, and remnant lesions between ESD and endoscopic mucosal resection(EMR). Subjects and methods: Two hundred fifty-two patients treated with ESD or EMR for histologically confirmed low-grade gastric epithelial
Volume 75, No. 4S : 2012
GASTROINTESTINAL ENDOSCOPY
AB364
17(38%), and C in 6(13%). The aetiology of liver disease was hepatitis B, hepatitis C, alcohol, and other causes in 7(16%), 26(57%), 5(11%), and 7(16%), respectively. The causes of biliary obstruction were classified as: bile duct stones: 18(40%), hemobilia: 4(9%) and malignant disease: 23(51%). Bile duct clearance was achieved in all the cases of stones. No serious early complications were observed. However, one patient undergoing hemodialysis had delayed biliary hemorrhage one week after the procedure and died from liver failure after two months. All patients with hemobilia were uneventfully cured by removing hematoma endoscopically. In 23 patients with malignant obstructive jaundice, hepatocellular carcinoma was detected in 16 patients, carcinoma of gallbladder in 2, bile duct carcinoma in 2, and pancreatic carcinoma in 3. There were 17 cases of hilar bile duct obstruction and 6 cases of extrahepatic biliary obstruction. An appropriate endoscopic biliary drainage procedure was successfully perfomed in all cases with no serious complication. An effective biliary drainage was achieved in 18 cases (78%). However, in 5 patients (22%), jaundice could not be improved and all those patients died within a few weeks. The risk factors for ineffective biliary drainage were hilar bile duct obstruction. Conclusion: Even in patients with liver cirrhosis, endoscopic procedures, to bile duct stones and hemobilia, can be safely and effectively carried out. On the other hand, we need a careful consideration to perform endoscopic drainage to malignant obstructive jaundice, especially in the cases of hilar bile duct obstruction.
Mo1244 Patterns of Split Dosing Recommendations for Colonoscopy Bowel Preparation: Results of a National Survey Grace Clarke Hillyer1, Benjamin Lebwohl*2,3, Corey Basch4, Charles Basch5, Fay Kastrinos2,3, Beverly J. Insel1, Alfred I. Neugut1,6 1 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; 2Division of Digestive and Liver Diseases, College of Physicians and Surgeons of Columbia University, New York, NY; 3Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons of Columbia University, New York, NY; 4 Department of Public Health, William Paterson University, Paterson, NJ; 5Department of Health and Behavior Studies, Teachers College of Columbia University, New York, NY; 6Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, NY Background: Rates of colorectal cancer have declined over the past 2 decades and have been attributed to increased rates of colorectal cancer screening, particularly colonoscopy. As a result, newer methods of improving bowel preparation quality have become increasingly important. Split dosing of the purgative has been consistently shown to improve bowel preparation quality, but little is known about the extent of its use in clinical practice. As part of a larger study to assess the relationship between self-reported proportion of suboptimal bowel preparations and bowel preparation recommendations, we sought to describe utilization of purgative split dosing as preparation for colonoscopy among gastroenterologists in the U.S. Methods: A randomly selected sample of the membership of a national professional organization of gastroenterologists was sent a web-based or postal survey between September 2010 and March 2011. Participants were queried about sociodemographic information, practice characteristics, and use of purgative split dosing. Comparisons were made between those participants who did and did not recommend split dosing and other covariates. Categorical data was analyzed using Pearson’s Chi square test of association. Results: A total of 1,355 physicians were invited to participate where 999 were eligible; 288 (29%) responded to the survey and 283 answered the question regarding split dosing. 60% of respondents indicated that they recommend split dosing; those using split-dose preparations had mean age of 50 years, were mostly white (62%), male (61%), and specified GI certification/ specialty (63%). Most practiced in urban settings (60%), had a private practice (64%), were affiliated with a non-teaching hospital (68%), and performed ⬎30 colonoscopies per week (71%). Split dosing of the purgative was associated with older age (⬎48 years) (67.2% vs. 53.2% for younger age, p ⫽ 0.02), private vs. hospital/university practice types (63.8% vs. 50.5%, p ⫽ 0.03), and non-teaching hospital affiliation (68.0% vs. 55.1%, p ⫽ 0.03). Conclusions: Our findings indicate that 60% of respondents utilize split dosing of purgative prior to colonoscopy. As split dosing is considered to be a key measure to improve the quality and cost-effectiveness of colonoscopy, this finding is encouraging. Surprisingly, older physicians, those in private practice, and those with nonteaching hospital affiliation were more likely to have adopted split dosing. Continuing medical education to increase utilization of the split dose purgative method is warranted.
Mo1245 Clinical Outcomes and Complications of Histoacryl Injection for Gastric Variceal Hemorrhage; What are the Determining Factors? Tanyaporn Chantarojanasiri*, Varayu Prachayakul, Pitulak Aswakul, Udom Kachintorn Gastroenterology, Siriraj Hospital, Bangkok, Thailand Background: Gastric variceal hemorrhage is an uncommon cause of upper gastrointestinal bleeding, mostly related to portal hypertension, however it associates with very high mortality and morbidity. Histoacryl injection had been reported to be effective haemostatic method, but it has several drawbacks due to complications. Up to the present, there was limited data regarding of the factors determining the clinical outcomes and complications. Aim: The aim of this study was to determine the factors associated with clinical outcomes and complications of histoacryl injection for gastric variceal hemorrhage. Materials and Methods: We conducted a retrospective review of the data of the adults who underwent Histoacryl Injection for Gastric Variceal Hemorrhage from April, 2008 to October 2011. The baseline characteristics, endoscopic finding, clinical characteristics, clinical outcomes and complications were analyzed. Results: A total of 88 procedures was enrolled, mean age 55.5 ⫾ 13.6 (15-88) years old, 73% of whom were male, the most common presentation were hemetemesis, melena and coffee ground emesis for 69.7%, 13.5% and 9.0% respectively. Initial haemostasis was 96.6% while re-bleeding in 120 hours was 10.1%. Early complications was 14.6% mainly from non fatal systemic embolizations(41.6%). The factors associated with complications were poor liver status, emergency endoscopy, concurrent hepatocellular carcinoma and larger amount of blood transfusion. Mortality rate was 21.3%, mostly related to infection. The factors associated with higher mortality were poor liver status, longer hospital stay, larger amount blood transfusion, longer duration of intravenous vasoactive agent and larger amount of injected histoacryl. Conclusion: Histoacryl injection for Gastric Variceal Hemorrhage was an excellent haemostatic methods with 14.6% of early complications. The clinical outcomes were mostly associated with clinical status of the patients more than the therapeutic procedure itself.
Mo1246 Colonoscopy Withdrawal Times and Adenoma Detection During Screening Colonoscopy Sandra Canseco, David Diaz, Carolina Bolino, Cecilio L. Cerisoli*, Luis E. Caro Gedyt, Buenos Aires, Argentina Introduction: Colonoscopy is widely recommended as the best method for Colorectal Cancer (CRC) screening. Being performed within ASGE quality indicators for colonoscopy these procedures are effective, safe and well tolerated. The U.S. Multi-Society Task Force and ASGE estimate that Adenomas Detection Rate (ADR) in asymptomatic healthy subjects ⱖ50 years should be 25% in men and 15% in women. According to experts, 6 minutes is the minimum length of time to allow adequate inspection during instrument withdrawal. Objective: To estimate if ADR is different in colonoscopy withdrawal time of ⬍ 6 minutes with the rate of those who had mean withdrawal time ⱖ 6 minutes. Materials and Methods: CRC average-risk adult population was included. Risk factors for CRC and adenomas, incomplete colonoscopies and colorectal surgeries were exclusion criteria. The study was carried out in an endoscopy center in Buenos Aires, Argentine, between August 2010 and August 2011. The study design was prospective, comparative, and observational and cross sectional. Colonoscopies were performed by 11 operators under sedation, administered by anesthesiologists. Polietilenglicol (PEG) with and without bisacodyl was used for cleansing. Polyps were resected with forceps, snare or Endoscopic Mucosal Resection (EMR). Histological assessment was done by three experienced pathologists in gastrointestinal tract. The protocol was approved by IRB. Statistical analysis: SPSS V16; 95% CI estimation, Chi Square, Fisher, Student test, Kolmogorov-Smirnov test, ANOVA, and Bonferroni test were used. Results: 594 patients were enrolled. Sample size characteristics are summarized in table 1. 1. ADR was 23.4% in the group of ⬍6 minutes (G1) vs. 21.8% in the group ⱖ 6 minutes (G2), (p⫽0.725). The analysis of the number of adenomas showed that higher percentage of patients with 2 or 3 adenomas were found in G2; this difference was statistically significant (p ⫽ 0.003). The differences between average withdrawal time according to number of adenomas were statistically significant (p ⬍0.001). Age, gender, time of day for performing the procedure and cleansing preparation were evaluated as possible factors for this finding. It was observed that patients with ⱖ 2 adenomas were significantly older than patients with at least 1 adenoma (p ⫽ 0.047). Conclusions: In our series no difference in ADT was found in different withdrawal times; however the number of adenomas detected in the procedures was higher in older patients who had colonoscopies with withdrawal time ⱖ 6 minutes. Future studies are needed to explain this finding. Table 1. Sample size characteristics
AB363 GASTROINTESTINAL ENDOSCOPY Volume 75, No. 4S : 2012
www.giejournal.org
Abstracts
Age (average) Females Males Total
Withdrawal time < 6 minutes (G1)
Withdrawal time > 6 minutes (G2)
54, 82 55,8% (n:155) 44.2% (n:123) 100% (n:278)
58, 22 54,7% (n:173) 45,3% (n:143) 100% (n:316)
Mo1247 Diagnosis of Laryngeal and Hypopharyngeal Diseases Can Be Done During Routine Upper Endoscopy Petr Vitek*1,3, Ivana Mikoviny Kajzrlikova1, Martin Hanousek2, Ondrej Urban2,3, Karol Zelenik4, Josef Chalupa1, Pavel Kominek4 1 Internal Medicine Department, Beskydy Gastrocentre, Frydek-Mistek, Czech Republic; 2Gastroenterology, Hospital Vitkovice, Ostrava, Czech Republic; 3Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic; 4Clinic of Otorhinolaryngology, University Hospital Ostrava, Ostrava, Czech Republic Introduction: Laryngeal and hypopharyngeal neoplastic and non-neoplastic diseases are frequently diagnosed at advanced stage. We have decided to evaluate ability of laryngeal and hypopharyngeal photography (LHP) performed during routine esophagogastroduodenoscopy (EGD) for diagnosis of laryngeal and hypopharyngeal diseases. Methods: In this pilot prospective bicentral study three standard LHPs (larynx, right and left piriform sinus) were recorded during all EGD performed during the study period of 1-9/2011. Epidemiologic data via questionnaire were obtained. LHPs were subsequently independently evaluated for presence of neoplastic and non-neoplastic lesions by gastroenterologist (GE) and otorhinolaryngologist (ORL) and clinical laryngeal and hypopharyngeal examination was performed if indicated by ORL. Inclusion criteria were age 1880 years and informed consent of patient. Odds ratios (ORs) and 95% confidence intervals (CI) were used to describe the associations. Results: Total number of 1224 patients (males 629, females 595, mean age 56 (SD ⫾ 15,8) years) were included. 35 (3%) patients were excluded from analysis because of low quality of LHPs. Based on LHPs, GE suspected patology in 5, 3% (64/1189) and ORL suspected patology in 58, 5% (696/1189) of patients. Clinical examination was indicated by ORL in 58 (4, 9%) of patients. The most frequent finding was reflux laryngitis in 653 (54,9%) patients. Laryngeal spinocellular carcinoma was found and histologically confirmed in 3 (0,3%) patients (all three males, mean age 60 years, all recognized both by GE and ORL), benign lesion in 56 (4, 7%) patients. There were no significant associations of reflux laryngitis in the bivariate analysis for age, sex, body mass index, presence of endoscopic esofagitis, smoking, alcohol, dysphagia, heartburn, hoarseness, diabetes and asthma. Conclusion: Laryngeal and hypopharyngeal photography were feasible in 97% of patients coming to routine EGD. We have found pathology in almost 60% of patients. The most frequent finding was reflux laryngitis, however we have also found 3 (0, 3%) laryngeal cancers. We have found no statistically significant association between reflux laryngitis and reflux esophagitis or reflux symptoms. We conclude that routine endoscopic examination of laryngeal and hypopharyngeal region during esophagogastroduodenoscopy could be beneficial for the patient.
Mo1248 Computer Based Virtual Reality Colonoscopy Simulation Improves Patient Based Colonoscopy Performance Keith S. Mcintosh*, Nitin V. Khanna, James C. Gregor Division of Gastroenterology, University of Western Ontario, London, ON, Canada Aims: The advancement of computer technology has led to the development of several virtual reality colonoscopy simulators. The potential benefits as a training tool include the ability to do an unlimited number of procedures with no risk of procedural related complications. Our aim in this study is to determine whether virtual reality simulator training translates into improved patient based colonoscopy performance. Methods: We enrolled 18 residents between PGY2 and PGY4 with no prior colonoscopy experience. They were assigned to be in either the simulator trained group (n ⫽ 10) or the non-simulator trained control group (n⫽8). The simulator group completed an average of 16 hours (range 12 20) on the Simbionix GI Mentor II colonoscopy simulator prior to patient based colonoscopy. We then evaluated both groups on their first 5 patient based colonoscopies, giving the residents a 15 minute time limit to reach the cecum. Objective: Outcome measures included the insertion time, depth of insertion and the number of assists required. Preset criteria for assisting fellows included making no forward progress with the scope over a period of 2 minutes. Subjective outcome measures included ratings of pain, attention to discomfort, and technique by the proctor, endoscopy nurse, and patient on a 5 point Likert scale. Results: Within the allotted time, the average distance reached was the hepatic flexure by the simulator group and the transverse colon by the controls (p⫽0.09). The simulator group required significantly less assists than the control
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group (1.94 vs. 3.43, p⫽⬍0.001), inserted the scope further unassisted (43cm vs. 24cm, p⫽0.003), and there was a trend to reach the cecum more often (26% vs. 10%, p⫽0.06). The simulator group received higher ratings of competence by both the proctors (2.28 vs. 1.88 out of 5, p⫽0.02) and the endoscopy nurses (2.56 vs. 2.05 out of 5, p⫽0.001). There were no significant differences in proctor, nurse or patient rated pain or attention to discomfort. Conclusions: In the initial stages of training, patient based colonoscopy performance is superior in simulator trained residents compared to non-simulator trained residents. The residents completing simulator training were all highly satisfied with the experience and this study indicates that at least 16 hours of training may be required for optimal benefit. As well, the method of providing “assists” to residents for challenging parts of the colonoscopy and returning the scope to them worked extremely well. Employing this technique, allowed the novice residents to perform successful and efficient colonoscopies with a high degree of patient satisfaction.
Mo1249 Gender Preference for Endoscopists Among US Muslims: A Population and Acculturation Based Survey Sabeen Abid*, Nandhakumar Kanagarajan, Scott Naples, Asyia S. Ahmad Medicine, Drexel University College of Medicine, Philadelphia, PA Background: Gender preference for endoscopist has been cited as being as high as 43% in women and 21% in men in a diverse US population. Factors that have shown to predict gender preference for endoscopist include gender, socioeconomic status and history of abuse. No study to date has looked at gender preference for endoscopist in a specific religious group. Objective: The aim of this study was to determine the gender preference for endoscopist in Muslims living in the US. Methods: Adult Muslims from three community centers completed a questionnaire that included patient demographics, country of origin, length of stay in US, income level, education level and gender preferences toward various health-care professionals including endoscopists. The validated Vancouver Index of Acculturation (VIA) survey was also administered in order to determine level of acculturation. Scores indicated if subjects predominantly associated themselves with people from their country of origin (heritage) or with Americans (mainstream). Results: There were 159 Muslims that completed the questionnaire of which 91(57%) were men and 68 (43%) were women. Gender preference for endoscopist in our Muslim population was 65.4%. Muslim women had a significantly higher gender preference for endoscopist as compared to Muslim men (82.3% vs. 52.7%; P value ⬍ 0.0001). One hundred percent of women and 94.4% of men with a gender preference expressed preference for an endoscopist of the same gender. Marital status, age, educational level, and socioeconomic status did not have a significant influence on gender preference for endoscopist. Muslims who lived in the US for ⬎10 years tended to have a higher gender preference for endoscopist as compared to those who did not (68.9% vs. 51%; P value⫽NS). Analysis of VIA score showed that 67.9% of Muslims had a high heritage score, 18.8% had a high mainstream score and 15% had both a high mainstream and a high heritage score. Women tended to have a high heritage score as compared to men (72% vs. 64.8%; P value⫽NS). Muslims with a high heritage score tended to have a gender preference as compared to those with a high mainstream score (66% vs. 53%; P value ⫽ NS). Women with a high heritage score were more likely to have a gender preference as compared to men with a high heritage score (85.7% vs. 50.8%; P value ⬍0.0002). Conclusion: Our study is the first to evaluate gender preference for endoscopist in the growing US Muslim population. Both Muslim men and women have a strikingly high gender preference for endoscopist. Muslim women who predominantly associate themselves with their heritage almost always prefer to have a woman perform their endoscopic procedures. Physician’s awareness of high gender preference rates in Muslims is crucial in improving patient comfort and compliance with endoscopic procedures in this population.
Mo1250 Is Endoscopic Mucosal Resection a Sufficient Treatment for Low-Grade Gastric Epithelial Dysplasia? Seul Young Kim*, Hyun Yong Jeong, Byung Seok Lee, Jaekyu Sung, Hee Seok Moon Chung Nam University Chung Nam University College of Medicine, Daejeon, Republic of Korea Purpose: Gastric adenoma with high-grade dysplasia (HGD) is an obvious precancerous lesion and needs aggressive treatment, such as surgery or endoscopic submucosal dissection(ESD). However, the natural history of lowgrade dysplasia (LGD)varies, and there is no treatment guideline for LGD. This study was performed to evaluate the risk factors for the progression of LGD to HGD or early gastric cancer (EGC) after endoscopic treatment. To determine the appropriate treatment for LGD,we compared the rates of complication, recurrence, and remnant lesions between ESD and endoscopic mucosal resection(EMR). Subjects and methods: Two hundred fifty-two patients treated with ESD or EMR for histologically confirmed low-grade gastric epithelial
Volume 75, No. 4S : 2012
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