- Email: [email protected]
Mo2057 Development of Novel Method for colorectal Endoscopic Submucosal Dissection using Carbon Dioxide Laser
Abstracts
were included. The included studies comprised of case reports, case series and clinical single-arm studies. Duplicate and review articles, animal studies, literatures in languages other than English and those without available abstracts were excluded. Results: Of the 572 results from the search, 135 abstracts met the inclusion criteria of which 53 were observational studies (82 were case reports). In the 53 studies reviewed, the technical success rate for OTSC deployment was 91.23% [95% confidence interval (CI), 84.21 to 98.25]. Overall clinical success rate across the board in all clinical applications based on current literature was 76.94% (95% CI, 69.42 to 84.46). OTSC has been reported to have more than 90% clinical success in management of GI bleeding, perforation closure, stent fixation, surgical dehiscence management and postbariatric surgery weight gain (Figure 1). No complications related to OTSC placement were reported. However, surgical interventions were reportedly required in 23.8% of cases after OTSC placement (95% CI, 3.65 to 44.09). Fistula recurrence was reported in 20% of cases and rebleeding was seen in 9% of cases (95% CI, -29.12 to 47.12). In the 82 individual case reports reviewed, OTSC was deployed in 92 patients (100% technical success). The main indications were fistula closure in 40/92 (43.4%) of cases, GI perforation closure in 27/92 (29.3%) of cases followed by GI Bleeding in 10/92 (10.8%) of cases. Overall clinical success was 97.8% in these reports. No complications related to OTSC application were reported. However only 2/92 patients (2.2%) required surgical intervention after OTSC placement. Conclusion: OTSC is safe and effective in most clinical situations with more than 90% success rates reported. The indications for OTSC application are continually expanding. Complication rates are low. It is a surgery-sparing tool in many cases and has become an indispensable device in the endoscopy units.
133.4kg on the day of surgery, reaching a minimum average weight of 90.1kg, a reduction of 32.4% over a period of 13.8 4 months and an average regain of 32kg and pre argon weight (kg) of 108.95 18.74. The patients were re-evaluate 5 weeks after the first session and reached a medium weight about 101.05 kg ( 18.07 kg), weight loss after argon (kg) 7.5 0.69. The pretreatment satiety was 5 points, to 7 points, with a decrease in caloric intake 1975.3 to 894.2. Conclusion: Treatment of weight regain after bariatric surgery through a minimally invasive procedure endoscopically, through coagulation with plasma of argon, was effective in the improvement of food satiety while reducing the caloric intake, as well as weight loss and with a satisfactory degree of security, not occurring complications in this series.
Timeline of weight regain and APC treatment Mo2056 Therapeutic With Argon Plasma Coagulation in Roux-en-Y Anastomosis for Weight Regain After Bariatric Surgery: CASE SERIES Thiago F. Souza1, Lucas M. Marques*1, Felipe P. Santos2, Gabriel C. Nunes2, Sergio Barrichello1, Eduardo Grecco1, Manoel Galvao Neto1 1 Endoscopy, Faculdade de Medicina do ABC, São Paulo, São Paulo, Brazil; 2Mario Covas Hospital, Santo André, Brazil Introduction: The endoscopic procedure after bariatric surgery, especially in Rouxen-Y gastric bypass, is safe and provides a review of the anastomosis and its restrictive capacity. The diameter of the anastomosis was a close relationship with the risk of weight regained after bariatric surgery, settling as a late post-surgical complication. The therapeutic with argon plasma coagulation is performed with a standard flexible endoscope. This procedure can be conducted outpatient under sedation. To achieve the desired diameter, the anastomosis should be treated circumferentially. The most patients need at least 2 or 3 sessions. The initial increase in restriction is dramatic and probably largely due to edema which accompanies the inflammatory response. Objective: The objective of this study was to evaluate weight loss, food intake and satiety scale after the first session of argon plasma coagulation in treatment of weight regain after gastric bypass for treatment of obesity. Methodology: This study was performed with monitoring of 10 patients who underwent a therapy for weight regain with first session application of argon plasma coagulation (APC) after RY gastric bypass. Was applied a subjective questionnaire of satiety to evaluate the food intake, pre and post APC treatment. After application, all patients were advised to follow a diet with progressive increase of food consistency. Results: We evaluated 10 patients, 70% female, mean age 56 years, mean weight
AB512 GASTROINTESTINAL ENDOSCOPY Volume 83, No. 5S : 2016
Mo2057 Development of Novel Method for colorectal Endoscopic Submucosal Dissection using Carbon Dioxide Laser Yoshinori Morita*, Tetsuya Yoshizaki, Ryusuke Ariyoshi, Takeshi Azuma Kobe University School of Medicine, Kobe, Japan Introduction: Recently, endoscopic treatment of early gastrointestinal cancer accomplished a big change by endoscopic submucosal dissection (ESD). In ESD procedure, a solution such as saline or sodium hyaluronate is usually injected into the submucosal layer to avoid the risk of perforation. However, ESD using conventional electrosurgical knives has problems such as the technical difficulty and the high rate of perforation especially for colorectal tumors because of the thinness of the wall. The success of the treatment depends on ability of each endoscopist. On the other hand, carbon dioxide (CO2) laser has been widely used for clinical surgery of otolaryngology, dermatology, and dentistry. Aim & Methods: The aim of this study was to develop a novel and safe method for ESD by using selective interaction caused by wavelength dependent absorption of laser in the mid-infrared wavelength range. In this study, CO2 laser with a wavelength of 10.6 mm was chosen because it is suitable for incision and coagulation, and is strongly absorbed by the water. We hypothesized that performing ESD using CO2 laser with a submucosal laser absorber could be a safe and simple ESD technique. To provide proof of concept regarding the feasibility of this novel method, an experimental study in vitro and in vivo porcine model was performed. A hollow optical fiber (J. Morita Mfg. Corp., Kyoto, Japan) optimized for the wavelength of the CO2 laser was used in this study. The inner diameter of the fiber was 530mm and the fiber can simultaneously transmit a visible laser as a guide laser. (1) In-vitro experiment: A resected porcine stomach was used as a sample. The laser irradiation was performed at output power 3W at a
www.giejournal.org
Abstracts
distance 2mm from the mucosal surface under these conditions, with or without injection of saline into the submucosa. The depth of incision was measured during each procedure. (2) In-vivo experiment: LWD pigs weighing 18.5kg were used under general anesthesia. A hollow optical fiber was passed through the endoscope (GIFQ260J, Olympus, Tokyo, Japan) channel, and ESD using CO2 laser was performed to the 6 rectal hypothetical lesions of 2cm. The collected samples were evaluated histologically. Results: (1) Perforation was only observed without submucosal injection. (2) En-bloc resections were achieved without perforation and muscular damage, and uncontrollable hemorrhage did not occur during the procedures. Conclusion: ESD using CO2 laser with submucosal laser absorber might be a feasible and safe method for the treatment of early colorectal tumors.
Mo2058 Diagnostic and Therapeutic ERCP Using a Short Type Double-Balloon Endoscope in Patients With Altered Gastrointestinal Anatomy: A Retrospective Evaluation of 890 Procedures Masaaki Shimatani*, Makoto Takaoka, Mitsuo Tokuhara, Kota Kato, Sachi Miyamoto, Hideaki Miyoshi, Tsukasa Ikeura, Kazushige Uchida, Kazuichi Okazaki Department of gastroenterology, kansai Medical University, Hirakata, Japan Background: The pancreatobiliary disease in patients with altered anatomic intestine is one of the most difficult cases for pancreatobiliary endoscopic therapies and diagnosis. There are two major challenges to overcome to complete the procedure. The first challenge is the deep insertion to the blind end. The second challenge is the ERCP-related intervention. Impairing either success means the incompletion of the procedure. The double balloon enteroscope (DBE) enabled the deep insertion to the blind end. Especially the advent of the short type DBE radically made the endoscopic approaches feasible for pancreatobiliary diseases in patients with altered gastrointestinal anatomy. Objective: We described our experience and data of DBERCP and provide our standard technique for DB-ERCP using a short type DBE. Patients and Methods: Between February 2006 and October 2015, we performed ERCP with the use of a short type DBE in 446 patients with various anatomic variations (890 procedures; 475 procedures (245 patients) for Roux-en-Y reconstruction (R&Y), 136 procedures (84 patients) for Billroth II gastorectomy (BII), 134 procedures (54 patients) for pancreatoduoderectomy (PD), 108 procedures (45 patients) for pylorus preserving pancreaticoduodenectomy (PpPD), and 37 procedures (18 patients) for others), and evaluated the technique. Result: Deep insertion of the short DBE to the ductal anastomosis or papilla was successful in 878 of the 890 procedures (98.7%). The success rate was 98.5% (468/475) for R&Y, 99.3% (135/136) for BII, 98.5% (132/134) for PD, 98.1% (106/108) for PpPD, and 100% (37/37) for others. Deep biliary cannulation was successful in 858 of the 878 procedures (97.7%). The success rate was 98.3% (460/468) for R&Y, 95.6% (129/135) for BII, 99.2% (131/132) for PD, 97.2% (103/106) for PpPD, and 94.6% (35/37) for others. Therapeutic intervention was achieved in all of the 858 procedures of successful deep cannulation (100%). Complications occurred in 47 of the 890 procedures (5.3%). The complication rate was 5.1% (24/475) for R&Y, 9.6% (13/136) for BII, 3.7% (5/134) for PD, 4.6% (5/108) for PpPD, and 0% (0/37) for others. Conclusions: ERCP by a short type DBE is highly effective and safety in patients with altered gastrointestinal anatomy, especially in patients with Roux-en-Y reconstruction. Occurrence of complication is within an acceptable range, however it is remarkable that it occurs more frequently in patients with BII unexpectedly.
Mo2059 Efficacy and Safety of Over-the-Scope Clip (OTSC) in the Endoscopic Closure of Fistula and Perforation in the Gastrointestinal Tract: A Case Series Alan Hoi Lun Yau*, Eric Lam, Robert A. Enns, Fergal Donnellan Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada Background: Over-the-scope clip (OTSC) (Ovesco Endoscopy GmbH, Tübingen, Germany) is a novel device utilized in the management of fistula, perforation, dehiscence, and bleeding in the gastrointestinal tract via tissue approximation and compression. Aims and Methods: A retrospective chart review was performed to determine the efficacy and safety of OTSC in the endoscopic closure of fistula and perforation in the gastrointestinal tract. Results: Seven patients (mean age 62.9 years; 3 women [42.9%]) were treated with OTSC from 10/13 to 03/15 in an outpatient (42.9%) or inpatient (57.1%) setting and on an elective (14.3%), semielective (42.9%), or urgent (42.9%) basis. The gastrointestinal diagnosis and treatment were nausea/vomiting with fistulizing percutaneous endoscopic gastrostomy tube (n Z 1), duodenal ulcer perforation with failed Graham omental patch (n Z 1), gastric cancer with total gastrectomy and leaking esophagojejunal anastomosis (n Z 1), transverse colon cancer with left hemicolectomy and fistulizing primary anastomosis (n Z 1), and rectosigmoid cancer with low anterior resection and leaking primary anastomosis (n Z 3). The OTSC was utilized in the endoscopic closure of
www.giejournal.org
gastrocutaneous fistula (n Z 1), duodenal ulcer perforation (n Z 1), jejunocutaneous fistula (n Z 1), colocutaneous fistula (n Z 1), and rectocutaneous fistula (n Z 3). The defect size ranged from 2 to 10 mm. Technical success with defect closure was achieved completely in 62.5% (5/8 clips) and partially in 25.0% (2/8 clips). There were no complications related to OTSC application. Additional interventions were hemoclips (n Z 2), argon plasma coagulation (n Z 1), sclerotherapy with histoacryl and lipiodol (n Z 2), and hyperbaric oxygen (n Z 1). Clinical success was achieved in 71.4% (n Z 5). One patient required surgical resection of fistula for definitive management. Another patient died of persistent bleeding from anastomotic site. Conclusions: The endoscopic application of OTSC appeared to be safe. The rates of technical success and long-term clinical success were satisfactory. Future prospective studies should compare the relative efficacy of OTSC to other endoscopic modalities in an effort to determine the most optimal indications and to maximize clinical outcomes.
Mo2060 Diagnostic Yield of Endoscopic Ultrasound - Fine Needle Aspiration with Flow Cytometry and Core Needle Biopsy in the Diagnosis of Lymphoma Gabriel D. Lang*1, Wenners Ballard2, Vladimir Kushnir1, Dayna S. Early1, Faris Murad1, Steven Edmundowicz1, Dan Mullady1 1 Gastroenterology, Washington University School of Medicine in Saint Louis, Saint Louis, MO; 2Internal Medicine, Washington University in Saint Louis, Saint Louis, MO Background: Endoscopic ultrasound-guided fine needle aspiration with flow cytometry (EUS-FNA/FC) and core needle biopsy (CNB) are important diagnostic tests in evaluating peri-gastrointestinal lymphadenopathy (LAD). However, the diagnostic accuracy of EUS-FNA/FC CNB for lymphoma and the role of EUS in subclassifying lymphoma without further invasive testing remains unclear. Aim: To determine yield of EUS-FNA/FC CNB in the diagnosis of patients with unexplained LAD. Methods: A retrospective cohort study of patients referred for EUS evaluation of unexplained lymphadenopathy without an associated mass lesion and/or history of solid organ malignancy from 2002-2015. Procedural reports, pathology and cytology data were obtained from medical records. The initiation of treatment based on results of EUSFNA/FCCNB was recorded. Final diagnosis was confirmed by the impression of the oncologist, histology or flow cytometry. Results: 152 patients met inclusion criteria (age 57.614.4, 58% male). Indications for EUS were: LAD in 134 patients (88.2%) and new LAD in patients with a history of lymphoma in 18 patients (11.8%). Location of LAD was intra-abdominal in 138 (91%) and mediastinal in 14 (9%). 82 (53.9%) patients underwent EUS-FNA/FC, 38 (25.1%) had EUS-FNA, 28 (18.4%) had EUSFNA/FC+CNB and 4 (2.6%) EUS-CNB alone. The final diagnoses were non-Hodgkin’s Lymphoma (NHL) in 51 (33.6%) patients, Hodgkin’s disease (HD) in 6 (3.9%), and non-malignant etiology in 95 (62.5%). Lymphoma diagnosis was made in 48/57 (84.2%) based on EUS-FNA/FC CNB; sensitivity 84.2%, specificity 100% & negative predictive value of 93%. Lymphoma subclassification was possible in 33/52 (63%) with NHL. 8 pts with NHL (15.6%) required excisional biopsy, 3 (5.5%) required ultrasound guided biopsy and 3 (5.5%) bone marrow aspiration to obtain a definitive diagnosis. Atypical or malignant cells were identified at EUS-FNA/FC in 5/6 (83%) pts with HD, all but one required a surgical biopsy to establish a definitive diagnosis. In the 95 patients without lymphoma, 80 (84.2%) had reactive LAD, 10 (10.5%) sarcoidosis and 5 (5.3%) an infectious etiology. Overall, EUS-FNA/FC CNB obviated the need for more invasive evaluation and was used to guide therapy in 65.5% of pts. Conclusion: EUS-FNA/FC CNB is a sensitive and specific method of evaluating unexplained lymphadenopathy. Additionally, EUS-FNA/FC CNB effectively diagnosis and subclassifies lymphoma. Improved tools for EUS-guided tissue acquisition will likely further improve diagnostic accuracy and ability to subclassify lymphoma in the future.
Mo2061 Comparison of Endoscopic Ultrasound Guided Fine Needle Aspiration By Capillary Action, Suction and No Suction Methods: A Randomized Blinded Study Rinkesh K. Bansal*, Narendra S. Choudhary, Rajesh Puri, Gaurav K. Patil, Rajiv R. Singh, Mukesh Nasa, Sumit Bhatia, Suraj Bhagat, Vinit Shah, Smruti R. Mishra, Randhir Sud Institute Of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Gurgaon, India Background: Different types of EUS-guided FNA techniques are used in clinical practice; the best method in term of outcome is not standardized. Objective: To compare capillary action, suction and no-suction methods of endoscopic ultrasound (EUS) guided fine needle aspiration (FNA). The cytopathologist was blinded to method of FNA. Methods: prospective, single-blind, randomized study conducted in a tertiary care hospital in north India. All consecutive adult patients presenting for EUS -FNA of solid organ lesions or lymph nodes were included in this study after proper consent. A total of 37 patients were excluded for various reasons and 100 patients in each arm were included. Patients were randomized to the three groups
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB513
were included. The included studies comprised of case reports, case series and clinical single-arm studies. Duplicate and review articles, animal studies, literatures in languages other than English and those without available abstracts were excluded. Results: Of the 572 results from the search, 135 abstracts met the inclusion criteria of which 53 were observational studies (82 were case reports). In the 53 studies reviewed, the technical success rate for OTSC deployment was 91.23% [95% confidence interval (CI), 84.21 to 98.25]. Overall clinical success rate across the board in all clinical applications based on current literature was 76.94% (95% CI, 69.42 to 84.46). OTSC has been reported to have more than 90% clinical success in management of GI bleeding, perforation closure, stent fixation, surgical dehiscence management and postbariatric surgery weight gain (Figure 1). No complications related to OTSC placement were reported. However, surgical interventions were reportedly required in 23.8% of cases after OTSC placement (95% CI, 3.65 to 44.09). Fistula recurrence was reported in 20% of cases and rebleeding was seen in 9% of cases (95% CI, -29.12 to 47.12). In the 82 individual case reports reviewed, OTSC was deployed in 92 patients (100% technical success). The main indications were fistula closure in 40/92 (43.4%) of cases, GI perforation closure in 27/92 (29.3%) of cases followed by GI Bleeding in 10/92 (10.8%) of cases. Overall clinical success was 97.8% in these reports. No complications related to OTSC application were reported. However only 2/92 patients (2.2%) required surgical intervention after OTSC placement. Conclusion: OTSC is safe and effective in most clinical situations with more than 90% success rates reported. The indications for OTSC application are continually expanding. Complication rates are low. It is a surgery-sparing tool in many cases and has become an indispensable device in the endoscopy units.
133.4kg on the day of surgery, reaching a minimum average weight of 90.1kg, a reduction of 32.4% over a period of 13.8 4 months and an average regain of 32kg and pre argon weight (kg) of 108.95 18.74. The patients were re-evaluate 5 weeks after the first session and reached a medium weight about 101.05 kg ( 18.07 kg), weight loss after argon (kg) 7.5 0.69. The pretreatment satiety was 5 points, to 7 points, with a decrease in caloric intake 1975.3 to 894.2. Conclusion: Treatment of weight regain after bariatric surgery through a minimally invasive procedure endoscopically, through coagulation with plasma of argon, was effective in the improvement of food satiety while reducing the caloric intake, as well as weight loss and with a satisfactory degree of security, not occurring complications in this series.
Timeline of weight regain and APC treatment Mo2056 Therapeutic With Argon Plasma Coagulation in Roux-en-Y Anastomosis for Weight Regain After Bariatric Surgery: CASE SERIES Thiago F. Souza1, Lucas M. Marques*1, Felipe P. Santos2, Gabriel C. Nunes2, Sergio Barrichello1, Eduardo Grecco1, Manoel Galvao Neto1 1 Endoscopy, Faculdade de Medicina do ABC, São Paulo, São Paulo, Brazil; 2Mario Covas Hospital, Santo André, Brazil Introduction: The endoscopic procedure after bariatric surgery, especially in Rouxen-Y gastric bypass, is safe and provides a review of the anastomosis and its restrictive capacity. The diameter of the anastomosis was a close relationship with the risk of weight regained after bariatric surgery, settling as a late post-surgical complication. The therapeutic with argon plasma coagulation is performed with a standard flexible endoscope. This procedure can be conducted outpatient under sedation. To achieve the desired diameter, the anastomosis should be treated circumferentially. The most patients need at least 2 or 3 sessions. The initial increase in restriction is dramatic and probably largely due to edema which accompanies the inflammatory response. Objective: The objective of this study was to evaluate weight loss, food intake and satiety scale after the first session of argon plasma coagulation in treatment of weight regain after gastric bypass for treatment of obesity. Methodology: This study was performed with monitoring of 10 patients who underwent a therapy for weight regain with first session application of argon plasma coagulation (APC) after RY gastric bypass. Was applied a subjective questionnaire of satiety to evaluate the food intake, pre and post APC treatment. After application, all patients were advised to follow a diet with progressive increase of food consistency. Results: We evaluated 10 patients, 70% female, mean age 56 years, mean weight
AB512 GASTROINTESTINAL ENDOSCOPY Volume 83, No. 5S : 2016
Mo2057 Development of Novel Method for colorectal Endoscopic Submucosal Dissection using Carbon Dioxide Laser Yoshinori Morita*, Tetsuya Yoshizaki, Ryusuke Ariyoshi, Takeshi Azuma Kobe University School of Medicine, Kobe, Japan Introduction: Recently, endoscopic treatment of early gastrointestinal cancer accomplished a big change by endoscopic submucosal dissection (ESD). In ESD procedure, a solution such as saline or sodium hyaluronate is usually injected into the submucosal layer to avoid the risk of perforation. However, ESD using conventional electrosurgical knives has problems such as the technical difficulty and the high rate of perforation especially for colorectal tumors because of the thinness of the wall. The success of the treatment depends on ability of each endoscopist. On the other hand, carbon dioxide (CO2) laser has been widely used for clinical surgery of otolaryngology, dermatology, and dentistry. Aim & Methods: The aim of this study was to develop a novel and safe method for ESD by using selective interaction caused by wavelength dependent absorption of laser in the mid-infrared wavelength range. In this study, CO2 laser with a wavelength of 10.6 mm was chosen because it is suitable for incision and coagulation, and is strongly absorbed by the water. We hypothesized that performing ESD using CO2 laser with a submucosal laser absorber could be a safe and simple ESD technique. To provide proof of concept regarding the feasibility of this novel method, an experimental study in vitro and in vivo porcine model was performed. A hollow optical fiber (J. Morita Mfg. Corp., Kyoto, Japan) optimized for the wavelength of the CO2 laser was used in this study. The inner diameter of the fiber was 530mm and the fiber can simultaneously transmit a visible laser as a guide laser. (1) In-vitro experiment: A resected porcine stomach was used as a sample. The laser irradiation was performed at output power 3W at a
www.giejournal.org
Abstracts
distance 2mm from the mucosal surface under these conditions, with or without injection of saline into the submucosa. The depth of incision was measured during each procedure. (2) In-vivo experiment: LWD pigs weighing 18.5kg were used under general anesthesia. A hollow optical fiber was passed through the endoscope (GIFQ260J, Olympus, Tokyo, Japan) channel, and ESD using CO2 laser was performed to the 6 rectal hypothetical lesions of 2cm. The collected samples were evaluated histologically. Results: (1) Perforation was only observed without submucosal injection. (2) En-bloc resections were achieved without perforation and muscular damage, and uncontrollable hemorrhage did not occur during the procedures. Conclusion: ESD using CO2 laser with submucosal laser absorber might be a feasible and safe method for the treatment of early colorectal tumors.
Mo2058 Diagnostic and Therapeutic ERCP Using a Short Type Double-Balloon Endoscope in Patients With Altered Gastrointestinal Anatomy: A Retrospective Evaluation of 890 Procedures Masaaki Shimatani*, Makoto Takaoka, Mitsuo Tokuhara, Kota Kato, Sachi Miyamoto, Hideaki Miyoshi, Tsukasa Ikeura, Kazushige Uchida, Kazuichi Okazaki Department of gastroenterology, kansai Medical University, Hirakata, Japan Background: The pancreatobiliary disease in patients with altered anatomic intestine is one of the most difficult cases for pancreatobiliary endoscopic therapies and diagnosis. There are two major challenges to overcome to complete the procedure. The first challenge is the deep insertion to the blind end. The second challenge is the ERCP-related intervention. Impairing either success means the incompletion of the procedure. The double balloon enteroscope (DBE) enabled the deep insertion to the blind end. Especially the advent of the short type DBE radically made the endoscopic approaches feasible for pancreatobiliary diseases in patients with altered gastrointestinal anatomy. Objective: We described our experience and data of DBERCP and provide our standard technique for DB-ERCP using a short type DBE. Patients and Methods: Between February 2006 and October 2015, we performed ERCP with the use of a short type DBE in 446 patients with various anatomic variations (890 procedures; 475 procedures (245 patients) for Roux-en-Y reconstruction (R&Y), 136 procedures (84 patients) for Billroth II gastorectomy (BII), 134 procedures (54 patients) for pancreatoduoderectomy (PD), 108 procedures (45 patients) for pylorus preserving pancreaticoduodenectomy (PpPD), and 37 procedures (18 patients) for others), and evaluated the technique. Result: Deep insertion of the short DBE to the ductal anastomosis or papilla was successful in 878 of the 890 procedures (98.7%). The success rate was 98.5% (468/475) for R&Y, 99.3% (135/136) for BII, 98.5% (132/134) for PD, 98.1% (106/108) for PpPD, and 100% (37/37) for others. Deep biliary cannulation was successful in 858 of the 878 procedures (97.7%). The success rate was 98.3% (460/468) for R&Y, 95.6% (129/135) for BII, 99.2% (131/132) for PD, 97.2% (103/106) for PpPD, and 94.6% (35/37) for others. Therapeutic intervention was achieved in all of the 858 procedures of successful deep cannulation (100%). Complications occurred in 47 of the 890 procedures (5.3%). The complication rate was 5.1% (24/475) for R&Y, 9.6% (13/136) for BII, 3.7% (5/134) for PD, 4.6% (5/108) for PpPD, and 0% (0/37) for others. Conclusions: ERCP by a short type DBE is highly effective and safety in patients with altered gastrointestinal anatomy, especially in patients with Roux-en-Y reconstruction. Occurrence of complication is within an acceptable range, however it is remarkable that it occurs more frequently in patients with BII unexpectedly.
Mo2059 Efficacy and Safety of Over-the-Scope Clip (OTSC) in the Endoscopic Closure of Fistula and Perforation in the Gastrointestinal Tract: A Case Series Alan Hoi Lun Yau*, Eric Lam, Robert A. Enns, Fergal Donnellan Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada Background: Over-the-scope clip (OTSC) (Ovesco Endoscopy GmbH, Tübingen, Germany) is a novel device utilized in the management of fistula, perforation, dehiscence, and bleeding in the gastrointestinal tract via tissue approximation and compression. Aims and Methods: A retrospective chart review was performed to determine the efficacy and safety of OTSC in the endoscopic closure of fistula and perforation in the gastrointestinal tract. Results: Seven patients (mean age 62.9 years; 3 women [42.9%]) were treated with OTSC from 10/13 to 03/15 in an outpatient (42.9%) or inpatient (57.1%) setting and on an elective (14.3%), semielective (42.9%), or urgent (42.9%) basis. The gastrointestinal diagnosis and treatment were nausea/vomiting with fistulizing percutaneous endoscopic gastrostomy tube (n Z 1), duodenal ulcer perforation with failed Graham omental patch (n Z 1), gastric cancer with total gastrectomy and leaking esophagojejunal anastomosis (n Z 1), transverse colon cancer with left hemicolectomy and fistulizing primary anastomosis (n Z 1), and rectosigmoid cancer with low anterior resection and leaking primary anastomosis (n Z 3). The OTSC was utilized in the endoscopic closure of
www.giejournal.org
gastrocutaneous fistula (n Z 1), duodenal ulcer perforation (n Z 1), jejunocutaneous fistula (n Z 1), colocutaneous fistula (n Z 1), and rectocutaneous fistula (n Z 3). The defect size ranged from 2 to 10 mm. Technical success with defect closure was achieved completely in 62.5% (5/8 clips) and partially in 25.0% (2/8 clips). There were no complications related to OTSC application. Additional interventions were hemoclips (n Z 2), argon plasma coagulation (n Z 1), sclerotherapy with histoacryl and lipiodol (n Z 2), and hyperbaric oxygen (n Z 1). Clinical success was achieved in 71.4% (n Z 5). One patient required surgical resection of fistula for definitive management. Another patient died of persistent bleeding from anastomotic site. Conclusions: The endoscopic application of OTSC appeared to be safe. The rates of technical success and long-term clinical success were satisfactory. Future prospective studies should compare the relative efficacy of OTSC to other endoscopic modalities in an effort to determine the most optimal indications and to maximize clinical outcomes.
Mo2060 Diagnostic Yield of Endoscopic Ultrasound - Fine Needle Aspiration with Flow Cytometry and Core Needle Biopsy in the Diagnosis of Lymphoma Gabriel D. Lang*1, Wenners Ballard2, Vladimir Kushnir1, Dayna S. Early1, Faris Murad1, Steven Edmundowicz1, Dan Mullady1 1 Gastroenterology, Washington University School of Medicine in Saint Louis, Saint Louis, MO; 2Internal Medicine, Washington University in Saint Louis, Saint Louis, MO Background: Endoscopic ultrasound-guided fine needle aspiration with flow cytometry (EUS-FNA/FC) and core needle biopsy (CNB) are important diagnostic tests in evaluating peri-gastrointestinal lymphadenopathy (LAD). However, the diagnostic accuracy of EUS-FNA/FC CNB for lymphoma and the role of EUS in subclassifying lymphoma without further invasive testing remains unclear. Aim: To determine yield of EUS-FNA/FC CNB in the diagnosis of patients with unexplained LAD. Methods: A retrospective cohort study of patients referred for EUS evaluation of unexplained lymphadenopathy without an associated mass lesion and/or history of solid organ malignancy from 2002-2015. Procedural reports, pathology and cytology data were obtained from medical records. The initiation of treatment based on results of EUSFNA/FCCNB was recorded. Final diagnosis was confirmed by the impression of the oncologist, histology or flow cytometry. Results: 152 patients met inclusion criteria (age 57.614.4, 58% male). Indications for EUS were: LAD in 134 patients (88.2%) and new LAD in patients with a history of lymphoma in 18 patients (11.8%). Location of LAD was intra-abdominal in 138 (91%) and mediastinal in 14 (9%). 82 (53.9%) patients underwent EUS-FNA/FC, 38 (25.1%) had EUS-FNA, 28 (18.4%) had EUSFNA/FC+CNB and 4 (2.6%) EUS-CNB alone. The final diagnoses were non-Hodgkin’s Lymphoma (NHL) in 51 (33.6%) patients, Hodgkin’s disease (HD) in 6 (3.9%), and non-malignant etiology in 95 (62.5%). Lymphoma diagnosis was made in 48/57 (84.2%) based on EUS-FNA/FC CNB; sensitivity 84.2%, specificity 100% & negative predictive value of 93%. Lymphoma subclassification was possible in 33/52 (63%) with NHL. 8 pts with NHL (15.6%) required excisional biopsy, 3 (5.5%) required ultrasound guided biopsy and 3 (5.5%) bone marrow aspiration to obtain a definitive diagnosis. Atypical or malignant cells were identified at EUS-FNA/FC in 5/6 (83%) pts with HD, all but one required a surgical biopsy to establish a definitive diagnosis. In the 95 patients without lymphoma, 80 (84.2%) had reactive LAD, 10 (10.5%) sarcoidosis and 5 (5.3%) an infectious etiology. Overall, EUS-FNA/FC CNB obviated the need for more invasive evaluation and was used to guide therapy in 65.5% of pts. Conclusion: EUS-FNA/FC CNB is a sensitive and specific method of evaluating unexplained lymphadenopathy. Additionally, EUS-FNA/FC CNB effectively diagnosis and subclassifies lymphoma. Improved tools for EUS-guided tissue acquisition will likely further improve diagnostic accuracy and ability to subclassify lymphoma in the future.
Mo2061 Comparison of Endoscopic Ultrasound Guided Fine Needle Aspiration By Capillary Action, Suction and No Suction Methods: A Randomized Blinded Study Rinkesh K. Bansal*, Narendra S. Choudhary, Rajesh Puri, Gaurav K. Patil, Rajiv R. Singh, Mukesh Nasa, Sumit Bhatia, Suraj Bhagat, Vinit Shah, Smruti R. Mishra, Randhir Sud Institute Of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Gurgaon, India Background: Different types of EUS-guided FNA techniques are used in clinical practice; the best method in term of outcome is not standardized. Objective: To compare capillary action, suction and no-suction methods of endoscopic ultrasound (EUS) guided fine needle aspiration (FNA). The cytopathologist was blinded to method of FNA. Methods: prospective, single-blind, randomized study conducted in a tertiary care hospital in north India. All consecutive adult patients presenting for EUS -FNA of solid organ lesions or lymph nodes were included in this study after proper consent. A total of 37 patients were excluded for various reasons and 100 patients in each arm were included. Patients were randomized to the three groups
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