- Email: [email protected]
Mo1609 Endoscopic Treatment for Tumorous Duodenal Lesions -EMR vs ESD-
Abstracts
UGIB with improved iron deficiency anemia after EE were defined as those with good clinical course. Results: [Clinical characteristics] 415 consecutive patients were enrolled. These patients were divided into 2 groups; group A (daytime on weekday admission: 185 patients [44.6%], mean age; 67.317.8 years) and group B (night on weekday or weekend admission: 230 patients [55.4%], mean age; 66.617.8 years). There was no significantly difference in the frequency of taking antithrombotics and non-steroidal anti-inflammatory drugs, although cerebrovascular diseases were significant more in group B (30.9%, pZ0.001) compare with group A (11.4%). Patients in group A (24.3%, pZ0.003) taking proton pomp inhibitors were significant more than group B (15.7%). Blood transfusion was more frequently observed in group A (53.0%, pZ0.011) compare with group B (40.4%).[Clinical course] The mortality rate was 3.6%. There was no significant difference in GB score (pZ0.17) and AIM65 score (pZ0.99) between the 2 groups and the rate of patients with clinical good course was not significantly different between group A (65.9%) and group B (63.9%, pZ0.67). However, patients in group B (57.8%, pZ0.006) who underwent EH were significantly more compare with group A (46.5%) (Fig). Conclusions: The mortality rate of Japanese patients with UGIB was lower than that of western patients. There were no significantly differences in clinical outcomes between daytime on weekday admission and others partly because patients could undergo enough EH even though on a weekday night or weekend.
Mo1608 Overt Obscure GI Bleed - Is a Tagged-Red-Blood-Cell Bleeding Scan Helpful? Bhaumik Brahmbhatt*, Michael J. Bartel, Carlos R. Simons Linares, Paul T. Kroner, Donnesha Clayton, Mark E. Stark, Frank Lukens Gastroenterology, Mayo Clinic, Jacksonville, FL Background & Aim: Tagged-red-blood-cell bleeding scan (tagged-RBC scan) are frequently used early in the work up overt obscure GI bleed (OGIB). It remains unclear if tagged-RBC scans are of benefit in the setting of overt OGIB, when patients eventually undergo therapeutic DBE. Methods: 1296 patients underwent 1747 double balloon enteroscopies (DBE) between 2/2009 and 9/2013 at a single tertiary center. Of those, 243 patients underwent 362 DBE (204 upper DBE and 158 lower DBE) for overt OGIB. Of the 243 patients, 55 patients underwent tagged-RBC scan within 24hours of overt OGIB. Data was abstracted by retrospective chart review. Main outcome was to identify if a possible bleeding scan increases the yield of DBE and eventually changes the rebleeding rate during follow up. Results: Baseline characteristics are shown in table 1. In summary, no statistical significant differences were noticed for gender, age, antiplatelet use, anticoagulation, number and yield of prior video capsule endoscopies (VCE) as well as the overall duration of overt OGIB prior DBE. Interestingly, the yield of DBE dropped from 70% to 60% (pZ0.03) following a positive tagged-RBC scan.Follow up duration following therapeutic DBE was 332 days in the positive tagged-RBC scan cohort and 404 days in the negative tagged-RBC scan cohort. Although not statistically significant, patients in the positive tagged-RBC scan cohort had a higher rate of rebleeding than patients with a negative tagged-RBC scan prior DBE (42% vs 19%). Limitations: Single center, retrospective study, small sample size, missing of other radiology and nuclear medicine techniques, lack of patients without tagged-RBC scanStrength: Long-term follow-up available. Conclusion: Tagged-RBC scans do not appear to be beneficial in patients with overt OGIB. The majority were negative (33 of 55; 60%) despite a timely overt bleed. Additionally, patients with a positive bleeding scan had eventually a lower yield of finding the culprit lesion on DBE. Overall, patients who underwent a taggedRBC scan prior DBE (nZ55) and no tagged-RBC scan prior DBE (nZ186) had similar yields to find the bleeding culprit lesion on DBE 65% vs. 67%.Small bowel hemorrhages tend to bleed frequently intermittently. Prolonging the diagnostic time prior the definite therapeutic DBE could explain why patients who undergo bleeding scan often have lower diagnostic yields.
AB482 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5S : 2015
Mo1609 Endoscopic Treatment for Tumorous Duodenal Lesions -EMR vs ESDYuichi Kojima*, Toshihisa Takeuchi, Naoki Yorifuji, Munetaka Iguchi, Kaori Fujiwara, Satoshi Harada, Kazuhiro Ota, Shoko Edogawa, Toshihiko Okada, Kazuki Kakimoto, Sadaharu Nouda, Ken Kawakami, Yosuke Abe, Takuya Inoue, Kazuhide Higuchi 2nd Dep of Internal Medicine, Takatsuki, Japan Purpose: Duodenal tumors are rare. Their biological malignancy remains to be clarified, and a consensus regarding therapeutic strategies has not been reached. Furthermore, there are few reports on endoscopic treatment. It is technically difficult, and complications may become serious. In this article, we present the results of endoscopic treatment for tumorous duodenal lesions in our hospital, and compare them among different procedures. Methods: The subjects were 24 patients who underwent endoscopic treatment in our hospital between April 2005 and May 2014 (8 with duodenal adenoma and 16 with early cancer). The procedures consisted of EMR in 12 patients (a two-channel scope was used), ESD in 8, and hybrid EMR in 4. The following items were compared between EMR and ESD/hybrid EMR groups (nZ12 each): age, sex, treatment phase (early phase: 2005 to 2009, late phase: 2010 to 2014), lesion site, size, macroscopic type, preoperative biopsy/pathology, operation time, presence or absence of hemostatic treatment, presence or absence of clip plication, pathological findings of a resected specimen, total resection rate, intra-/ postoperative perforation rate, and residual tumor/recurrence rate. Results: There were no significant differences in the patient age or sex between the two groups. The lesion size was larger in the ESD/hybrid EMR group. However, there were no significant differences in the site or macroscopic type. When the results of preoperative biopsy were evaluated as Group 5, ESD or hybrid EMR was selected. In the EMR group, clip plication was performed. In the ESD/hybrid EMR group, the total and curative resection rates were significantly higher than in the EMR group, but the intraoperative perforation rate was also significantly higher. In 1 patient, the procedure was switched to emergency surgery intraoperatively (the patient had received steroid therapy). There was no association between the intraoperative perforation rate and underlying disease/oral administration of antithrombotic drugs. During a 7-year follow-up, multiple metachronal lesions were noted in 1 patient. In a significantly higher proportion of patients taking antithrombotic drugs, EMR was selected. Conclusion: ESD for duodenal tumors was compared with EMR. In patients who underwent ESD, the intraoperative perforation rate was higher, suggesting technical difficulty. On the other hand, in the EMR group, the proportion of patients with positive reactions at the margin of the resected specimen was higher; long-term follow-up may be necessary. The two procedures have some merits and limitations, but the selection of an appropriate procedure must be examined to improve the total resection rate and prevent complications in the future.
Mo1610 Usability Assessment of Endoscopic Mucosal Resection With a CAP-Fitted Panendoscope for Superficial Epithelial Type of Sporadic Non-Ampullary Duodenal Adenoma/Carcinoma Daisuke Maruoka*1,2, Makoto Arai1, Hideaki Ishigami1, Kenichiro Okimoto1, Shoko Minemura1, Tomoaki Matsumura1, Tomoo Nakagawa1, Tatsuro Katsuno1, Osamu Yokosuka1 1 Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan; 2Clinical Research Center, Chiba University Hospital, Chiba, Japan Aims: In the duodenum, en bloc resection is often difficult by conventional endoscopic mucosal resection (EMR) especially of superficial epithelial lesions, which do not have any type I (protruded) component because adequate mucosal lift by submucosal injection is often inhibited by the existence of Brunner’s glands. Meanwhile, the rate of en bloc resection of endoscopic submucosal dissection (ESD) in the duodenum is high. However, the rate of ESD complications, such as perforation, in the duodenum is much higher than that in the other digestive tracts, and
www.giejournal.org
UGIB with improved iron deficiency anemia after EE were defined as those with good clinical course. Results: [Clinical characteristics] 415 consecutive patients were enrolled. These patients were divided into 2 groups; group A (daytime on weekday admission: 185 patients [44.6%], mean age; 67.317.8 years) and group B (night on weekday or weekend admission: 230 patients [55.4%], mean age; 66.617.8 years). There was no significantly difference in the frequency of taking antithrombotics and non-steroidal anti-inflammatory drugs, although cerebrovascular diseases were significant more in group B (30.9%, pZ0.001) compare with group A (11.4%). Patients in group A (24.3%, pZ0.003) taking proton pomp inhibitors were significant more than group B (15.7%). Blood transfusion was more frequently observed in group A (53.0%, pZ0.011) compare with group B (40.4%).[Clinical course] The mortality rate was 3.6%. There was no significant difference in GB score (pZ0.17) and AIM65 score (pZ0.99) between the 2 groups and the rate of patients with clinical good course was not significantly different between group A (65.9%) and group B (63.9%, pZ0.67). However, patients in group B (57.8%, pZ0.006) who underwent EH were significantly more compare with group A (46.5%) (Fig). Conclusions: The mortality rate of Japanese patients with UGIB was lower than that of western patients. There were no significantly differences in clinical outcomes between daytime on weekday admission and others partly because patients could undergo enough EH even though on a weekday night or weekend.
Mo1608 Overt Obscure GI Bleed - Is a Tagged-Red-Blood-Cell Bleeding Scan Helpful? Bhaumik Brahmbhatt*, Michael J. Bartel, Carlos R. Simons Linares, Paul T. Kroner, Donnesha Clayton, Mark E. Stark, Frank Lukens Gastroenterology, Mayo Clinic, Jacksonville, FL Background & Aim: Tagged-red-blood-cell bleeding scan (tagged-RBC scan) are frequently used early in the work up overt obscure GI bleed (OGIB). It remains unclear if tagged-RBC scans are of benefit in the setting of overt OGIB, when patients eventually undergo therapeutic DBE. Methods: 1296 patients underwent 1747 double balloon enteroscopies (DBE) between 2/2009 and 9/2013 at a single tertiary center. Of those, 243 patients underwent 362 DBE (204 upper DBE and 158 lower DBE) for overt OGIB. Of the 243 patients, 55 patients underwent tagged-RBC scan within 24hours of overt OGIB. Data was abstracted by retrospective chart review. Main outcome was to identify if a possible bleeding scan increases the yield of DBE and eventually changes the rebleeding rate during follow up. Results: Baseline characteristics are shown in table 1. In summary, no statistical significant differences were noticed for gender, age, antiplatelet use, anticoagulation, number and yield of prior video capsule endoscopies (VCE) as well as the overall duration of overt OGIB prior DBE. Interestingly, the yield of DBE dropped from 70% to 60% (pZ0.03) following a positive tagged-RBC scan.Follow up duration following therapeutic DBE was 332 days in the positive tagged-RBC scan cohort and 404 days in the negative tagged-RBC scan cohort. Although not statistically significant, patients in the positive tagged-RBC scan cohort had a higher rate of rebleeding than patients with a negative tagged-RBC scan prior DBE (42% vs 19%). Limitations: Single center, retrospective study, small sample size, missing of other radiology and nuclear medicine techniques, lack of patients without tagged-RBC scanStrength: Long-term follow-up available. Conclusion: Tagged-RBC scans do not appear to be beneficial in patients with overt OGIB. The majority were negative (33 of 55; 60%) despite a timely overt bleed. Additionally, patients with a positive bleeding scan had eventually a lower yield of finding the culprit lesion on DBE. Overall, patients who underwent a taggedRBC scan prior DBE (nZ55) and no tagged-RBC scan prior DBE (nZ186) had similar yields to find the bleeding culprit lesion on DBE 65% vs. 67%.Small bowel hemorrhages tend to bleed frequently intermittently. Prolonging the diagnostic time prior the definite therapeutic DBE could explain why patients who undergo bleeding scan often have lower diagnostic yields.
AB482 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5S : 2015
Mo1609 Endoscopic Treatment for Tumorous Duodenal Lesions -EMR vs ESDYuichi Kojima*, Toshihisa Takeuchi, Naoki Yorifuji, Munetaka Iguchi, Kaori Fujiwara, Satoshi Harada, Kazuhiro Ota, Shoko Edogawa, Toshihiko Okada, Kazuki Kakimoto, Sadaharu Nouda, Ken Kawakami, Yosuke Abe, Takuya Inoue, Kazuhide Higuchi 2nd Dep of Internal Medicine, Takatsuki, Japan Purpose: Duodenal tumors are rare. Their biological malignancy remains to be clarified, and a consensus regarding therapeutic strategies has not been reached. Furthermore, there are few reports on endoscopic treatment. It is technically difficult, and complications may become serious. In this article, we present the results of endoscopic treatment for tumorous duodenal lesions in our hospital, and compare them among different procedures. Methods: The subjects were 24 patients who underwent endoscopic treatment in our hospital between April 2005 and May 2014 (8 with duodenal adenoma and 16 with early cancer). The procedures consisted of EMR in 12 patients (a two-channel scope was used), ESD in 8, and hybrid EMR in 4. The following items were compared between EMR and ESD/hybrid EMR groups (nZ12 each): age, sex, treatment phase (early phase: 2005 to 2009, late phase: 2010 to 2014), lesion site, size, macroscopic type, preoperative biopsy/pathology, operation time, presence or absence of hemostatic treatment, presence or absence of clip plication, pathological findings of a resected specimen, total resection rate, intra-/ postoperative perforation rate, and residual tumor/recurrence rate. Results: There were no significant differences in the patient age or sex between the two groups. The lesion size was larger in the ESD/hybrid EMR group. However, there were no significant differences in the site or macroscopic type. When the results of preoperative biopsy were evaluated as Group 5, ESD or hybrid EMR was selected. In the EMR group, clip plication was performed. In the ESD/hybrid EMR group, the total and curative resection rates were significantly higher than in the EMR group, but the intraoperative perforation rate was also significantly higher. In 1 patient, the procedure was switched to emergency surgery intraoperatively (the patient had received steroid therapy). There was no association between the intraoperative perforation rate and underlying disease/oral administration of antithrombotic drugs. During a 7-year follow-up, multiple metachronal lesions were noted in 1 patient. In a significantly higher proportion of patients taking antithrombotic drugs, EMR was selected. Conclusion: ESD for duodenal tumors was compared with EMR. In patients who underwent ESD, the intraoperative perforation rate was higher, suggesting technical difficulty. On the other hand, in the EMR group, the proportion of patients with positive reactions at the margin of the resected specimen was higher; long-term follow-up may be necessary. The two procedures have some merits and limitations, but the selection of an appropriate procedure must be examined to improve the total resection rate and prevent complications in the future.
Mo1610 Usability Assessment of Endoscopic Mucosal Resection With a CAP-Fitted Panendoscope for Superficial Epithelial Type of Sporadic Non-Ampullary Duodenal Adenoma/Carcinoma Daisuke Maruoka*1,2, Makoto Arai1, Hideaki Ishigami1, Kenichiro Okimoto1, Shoko Minemura1, Tomoaki Matsumura1, Tomoo Nakagawa1, Tatsuro Katsuno1, Osamu Yokosuka1 1 Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan; 2Clinical Research Center, Chiba University Hospital, Chiba, Japan Aims: In the duodenum, en bloc resection is often difficult by conventional endoscopic mucosal resection (EMR) especially of superficial epithelial lesions, which do not have any type I (protruded) component because adequate mucosal lift by submucosal injection is often inhibited by the existence of Brunner’s glands. Meanwhile, the rate of en bloc resection of endoscopic submucosal dissection (ESD) in the duodenum is high. However, the rate of ESD complications, such as perforation, in the duodenum is much higher than that in the other digestive tracts, and
www.giejournal.org