P255 E-mail reminders and adherence rates to medical treatment in patients with inflammatory bowel disease

S112 P255 E-mail reminders and adherence rates to medical treatment in patients with inflammatory bowel disease A. Hernandez Camba1 *, M. Carrillo1 , L. Ramos1 , I. Alonso1 , N. Hernandez Alvarez-Buylla1 , O. Alarcon Fernandez1 , A. Jimenez Sosa2 , E. Quintero1 . 1 Hospital Universitario de Canaris, Gastroenterology, La Laguna, Spain, 2 Hospital Universitario de Canaris, Research Unit, La Laguna, Spain Background: Non-adherence to medical treatment in patients with inflammatory bowel disease (IBD) is a well known fact and it is associated with an increased risk of relapse and health care costs. Usefulness of e-mail reminders to improve patient compliance has not been reported previously. Methods: We performed a prospective study at the Hospital Universitario de Canarias. Patients with IBD diagnosed at least 6 months before, 18 y or older were included. We excluded patients on steroids, pregnant women and those unable to sign the informed consent. Demographic data, including Internet use, were registered. Medical data (years from diagnosis, type and extension of IBD, medication, related surgery, Mayo or CDAI index and a quality of life questionnaire) were also recorded. Adherence to medical treatment was determined with a previously validated questionnaire. We included three groups of patients: group A Internet non users, group B Internet users without e-mail reminders and group C Internet users with e-mail reminders. Non Internet users were followed as usual. Patients in the Internet group users were randomized to standard follow-up appointments plus periodic e-mail reminders or just to regular follow-up consultations. Adherence was determined at the beginning of the study and at six and twelve months. Results: From June 2011 to November 2011, 168 patients were included (79% F) and followed for one year. 86 had ulcerative colitis, 79 Crohn’s disease and 3 indeterminate colitis. 131 patients (78%) were Internet users and 37 not users. 61 Internet users were randomized to the e-mail remainder group. Initial global adherence was 34.3% in group A, 27.8% in group B and 26.2% in group C (p = n.s). At the end of the study, global adherence rates were 83.3% in group A, 71.8% in group B and 73.2% in group C (p = n.s). When analyzing the subtype of non-adherence we did not find either any difference between groups. There were no differences between groups regarding complications, need to change to steroids or biological therapy, surgery, hospitalizations or any other complication. CDAI, Mayo and quality of life scores were similar between the three groups at the end of the follow-up. Conclusions: The use of e-mail reminders do not improve adherence to medical treatment in patients with IBD when compared with standard follow-up. Regular follow up with appropriate medical information seems to be enough to improve the adherence rate in IBD patients. P256 Dysplasia and colorectal cancer in surveillance colonoscopies of ulcerative colitis in a single center: retrospective study nate1 *, P. Saiz1 , A. Monescillo1 , N. Hernandez1 , M. Pe˜ E. Jimenez1 , M.A. S´ anchez2 , A. Castellot1 , J.M. Marrero1 , A. Sierra1 . 1 Hospital Universitario Insular de Gran Canaria, Servicio Aparato Digestivo, Las Palmas de Gran Canaria, Spain, 2 Hospital Universitario Insular de Gran Canaria, Servicio Anatomía Patol´ ogica, Las Palmas de Gran Canaria, Spain Background: Inflammatory bowel disease is one of the predisposing conditions for cancer colorectal and it is preceded by dysplasia. Although no large controlled trial has proven that surveillance reduces mortality, it is recommended by the mayor Societies. Our objectives were (1) evaluate in our hospital dysplasia and CRC diagnosed by conventional colonoscopy in our patients with UC undergoing colonoscopy surveillance based

Poster presentations standard recommendations, to introduce chromoendoscopy into our protocols and (2) assess homogeneity in the sampling according to the guidelines. Methods: Retrospective study in patients with UC who were under surveillance endoscopy of dysplasia/CRC in the last 5 years. The data were obtained from reports of colonoscopy and pathology. In cases of dysplasia or CRC, medical records were reviewed. Results: 254 colonoscopies in 130 patients: 52% males, mean age: 51±13 years. Location at diagnosis: proctitis (E1) 16%, left colitis (E2) 49% and extensive (E3) 31%. Mean duration of disease was 15±6 years. 2.4±2 colonoscopies were performed in each patient. 93% completes; no endoscopy activity in 71% and activity histology in 53%. The total number of biopsies ranged between 25 30 in 14 colonoscopies. Polypoid lesions 69% (35% multiples): appearance inflammatory pseudopolyps 37% (histology features 100%). Sporadic adenomas 1.5% (4), mean age 60 years without cancer risk, in an area without endoscopic and histology inflammation: 1 right, 2 left colon and 1 rectum; 3 adenomas and 1 in situ carcinoma. Dysplasia: 2.7% (7), 8 dysplasia (2 in the same): high grade 2 (25%) and low grade 6 (75%). Low-grade flat dysplasia: 5 (63%), DALM or dysplasia associated mass 1 (13%), high-grade flat dysplasia 1 (13%). Treatments all 5-ASA, 3 AZA and 1 IFX. 1 CEP. CRC 0.7% (2) with age at diagnosis 51 years, in treatment with 5-ASA. Location 1 left colon and synchronous lesion in left and right colon. Histological adenocarcinoma. No CEP. Conclusions: (1) Although the percentage dysplasia/CRC is low in our series, it is there. (2) Significantly associated with histologic activity and extend of disease at diagnosis, so that mucosal and histological healing must be the objective medical treatment. (3) Multiple polypoid lesions were found which makes difficult the blind sampling (4) As general population, sporadic adenomas appear to old age. (5) Random sampling was homogeneous. In conclusion it would useful endoscopic techniques for surveillance allow guided biopsies to increased sensibility and decrease complexity. P257 Double-balloon enteroscopy in Crohn’s disease with small bowel involvement: the characteristics and clinical significance S.R. Jeon1 *, J.-O. Kim1 , H.G. Kim1 , T.H. Lee1 , W.J. Kim1 , B.M. Ko1 , J.Y. Cho1 , J.S. Lee1 , M.S. Lee1 . 1 Institute of Digestive Research, Soonchunhyang University College of Medicine, Department of Internal Medicine, Seoul, South Korea Background: Diagnosis of Crohn’s disease (CD) in small bowel (SB) is difficult beyond the reach of standard endoscopy. Although double-balloon enteroscopy (DBE) enables endoscopic visualization of the SB, the available data of CD with SB involvement is limited. Therefore, the aim of this study was to evaluate the characteristics by DBE and to identify clinical impact of DBE. Methods: The study was conducted in a tertiary care center. We retrospectively analyzed 30 CD patients who were diagnosed by DBE (39 procedures) between September 2004 and October 2012. Phenotype was classified according to Montreal classification. Results: The mean age of patients was 36.4 years and 73.2% of patients were male. The most common indication was to make the initial diagnosis (12/30, 40%). The mean number of procedures per patient was 1.3 and the elapsed time to the deepest point was 46.3±36.1 minutes. No complications occurred. CD activity was found: grade 1, 2, 3 and 4 were 26.7% (8/30), 36.7% (11/30), 0% and 36.7% (11/30), respectively. The extended CD was detected in 93.3% (28/30) and the most common behavior was B1 in 66.7% (20/30). Location of CD was as in the following: L4 (50%), L1+L4 (26.7%), L2+L4