S1549: Association Between Serum Albumin Levels and Computed Tomography (CT) Findings of Colon Wall Thickening (CWT)

Abstracts acceptable. An invasion of malignant cells to the superficial submucosa(sm1) requires endoscopic en bloc resection by either EMR or endoscopic submucosal dissection (ESD). Deep submucosal (sm 2,3) and muscularis propria invasions warrants surgery. EUS miniprobes(EUSmp) have been reported to be useful in local staging, but their application in all cases is not acceptable in clinical practice.Aims and methods:The purpose of this prospective study was to evaluate the impact of EUSmp staging on the treatment of SCN in regard to their endoscopic characteristics.Patients with SCN referred to our facility for primary endoscopic treatment during the period of 11/2008 - 10/2009 were enrolled. Lesions type 0Ip and 0IIa ⬍ 10 mm in diameter were excluded. Morphology was diagnosed according to Paris endoscopic classification and pit pattern according to the system developed by Kudo. High risk endoscopic features for submucosal invasion included depressed areas and pit patterns III and Vi,n. EUS catheter miniprobes with a frequency of 20 or 30 MHz were used. The preoperative staging has been compared to that of a histopathology examination of either endoscopically or surgically obtained specimens.Results:A total of 40 SCN (rectum 21, colon 19) in 40 patients (F 20, mean age 64 years) were diagnosed. Of these 13(33%) were 0Is, 22(55%) were LST, 1(2%) 0IIc, 4(10%) 0IIa⫹IIc. The average diameter was 24 (8-50) mm.A total of 6(15%) lesions could not be completely examined with EUSmp and were excluded from further considerations. A total of 25 (74%) were considered high risk, with their local EUS staging: uT1m:16(64%), uT1sm1:1(4%), uT1sm2,3:4(16% ),uT2:4(16% ). All 9(26%) low-risk lesions were uT1m. Local staging was accurate in 31(91%) of the cases. In the rest of 3 cases(9%) the EUS staging was incorrect(1 lesion overstaged, 2 understaged). EUSmp examination changed the subsequent therapeutic approach in 10 of 25 (40%) high-risk lesions and 0 of 9(0%) low-risk lesions. Conclusion:The impact of EUSmp staging on the treatment of SCN depends on endoscopic characteristics of the lesions.It is negligible in low-risk SCN and these lesions can be treated on the basis of endoscopic appearance only. Nevertheless, EUSmp staging changes the subsequent therapeutic approach in up to 40% of high-risk lesions, including those containing depressed areas and advanced pit pattern.

prospectively evaluated. Data were collected until discharge or 30 days & SAS was used for data management. IC Dx was made on appearance, histopathology, & negative testing for other types of colitis. RESULTS: Of 550 consecutive pts in the last 12 years with severe LGIB from colonic sources, 65 were caused by IC. Female gender, any anticoagulant use, significant lung disease, units of fresh frozen plasma (UFFP) transfused, creatinine, & glucose were significantly higher in the IC group. On colonoscopy, most pts had several colonic areas of IC, but 5 pts had focal ulcers with stigmata & had hemoclipping. Major 30 day outcomes of IC pts were significantly worse than pts with other colonic Dxs. Refer to Table 1. Pts with inpt vs outpt IC had significantly more & severe comorbidities & significantly higher rates of rebleeding, surgery & more hospital & intensive care unit (ICU) days. See Table 2. CONCLUSIONS: Compared to pts with severe LGIB & non-IC colon diagnoses, those caused by IC 1) had a significantly higher prevalence of anticoagulant usage, lung disease, & higher creatinine, glucose & more UFFP transfusion, 2) all had diffuse IC except 5 pts with focal lesions who had colonoscopic hemostasis, 3) major 30 day outcomes of pts with IC were significantly worse than pts with other colonic diagnoses, & 4) comparing outpt vs inpt start of IC, inpts had significantly worse outcomes.(Supported in part by NIH CURE Grant (P30-DK04130) & NIH K24(02650)). Table 1: 30 Day Outcomes of 65 Patients with IC vs. 485 Patients with Other Colonic Diagnoses # of pts. Colonoscopic Hemostasis Rebleeding Surgery Mean ICU Days (⫾SE) Mean Hospital Days (⫾SE) Death

Ischemic Colitis

All Other Diagnoses

p value

65 5/65 (7.7%) 18/65 (27.7%) 9/65 (13.9%) 3.6 ⫾ 1.0 11.8 ⫾ 1.4 5/65 (7.7%)

485 203/485 (41.9%) 61/485 (12.6%) 27/485 (5.6%) 2.2 ⫾ 0.3 6.5 ⫾ 0.4 16/485 (3.3%)

⬍0.0001 0.0041 0.0113 0.1 0 0.0826

Table 2: 30 Day Outcomes of Inpatient vs. Outpatient Ischemic Colitis

S1547 Risk of Colorectal Adenomas in Patients With Solid Organ Transplantation Ho Yong Park, So Young Bae, Hyuk Lee, Jin Yong Kim, Dong Kyung Chang, Hee Jung Son, Poong-Lyul Rhee, Jae J Kim, Jong Chul Rhee, Young-Ho Kim Background and aims: The increased incidence of malignancy after solid organ transplantation (SOT) has been documented. However, the incidence of colorectal adenomas in the transplant population has not yet been well characterized. The aim of this study was to determine whether there was an increased incidence of colorectal adenoma in SOT recipients compared with average risk population. Methods: We reviewed 390 patients with solid organ transplants who underwent colonoscopy from February 1995 to July 2008 and 2084 patients in an average risk population who underwent colonoscopic examination from March 2004 to December 2005. We compared the incidence of adenomatous polyps, advanced adenomas (adenomas ⱖ 10mm, villous histology, high grade dysplasia), and cancers in these groups. Results: There were 235 (60.3%) males in the SOT group and 1561 (74.9%) males in the control group (p⫽0.000). A mean age was 47.9⫾10.7 years in the SOT group and 51.2⫾7.8 years in the control group (p⫽0.000). A total of 94 (24.1%) adenomas were found in the SOT group while 554 (26.6%) were found in the control group (p⫽0.306). There was a statistically significant difference (p⫽0.019) in the number of patients with advanced adenomas in the SOT group (19 patients, 4.9%) compared with the control group (56 patients, 2.7%). A total of 4 (1.0%) cancers were found in the SOT group while 7 (0.3%) cancers were found in the screening group (p⫽0.080). The independent risk factors of advanced adenomas were age (50 years or more, odds ratio (OR)⫽2.99; 95% CI 1.74-5.13), male sex (OR⫽2.75; 95% CI 1.40-5.42), and transplantation (OR⫽1.96; 95% CI 1.08-3.55). Conclusion: Because the incidence of advanced adenomas was significantly higher in SOT recipients compared with an average risk population, a prospective study was required to formulate a sound colonoscopic surveillance plan in the transplant population.

S1548 Ischemic Colitis Is a Common Cause of Severe Hematochezia and Patient Outcomes Are Worse Than With Other Colonic Diagnoses Disaya Chavalitdhamrong, Dennis M. Jensen, Thomas O. Kovacs, Gareth S. Dulai, Rome Jutabha, Gordon V. Ohning, Gustavo A. Machicado Ischemic colitis (IC) is a common cause of severe hematochezia (LGIB), especially in elderly patients (pts). PURPOSES: To compare: 1) demographics & outcomes of pts hospitalized with severe LGIB & IC to other colonic diagnoses (Dx), & 2) inpt vs outpt start of IC bleeding. METHODS: All pts were

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Rebleeding Mean Total URBC (⫾SE) Mean Hospital Days (⫾SE) Mean ICU Days (⫾SE) Surgery Death

Outpatient group (Nⴝ36)

Inpatient Group (Nⴝ29)

p value

16.7% 0.6 ⫾ 0.2 4.8 ⫾ 1.0 0.6 ⫾ 0.5 5.6% 2.8%

41.4% 9.5 ⫾ 2.8 20.8 ⫾ 1.8 7.6 ⫾ 2.1 24.1% 13.8%

0.0269 0 0 0 0.0311 0.098

S1549 Association Between Serum Albumin Levels and Computed Tomography (CT) Findings of Colon Wall Thickening (CWT) Hiral Shah, Bikram S. Bal, Raman Battish, Michael D. Crowell, Rohini R. Vanga, Wissam E. Mattar, Kevin W. Olden Background: CWT is a common finding on CT scans. Incidental findings of CWT often prompt further evaluation by colonoscopy. Endoscopic evaluation of CWT in the setting of abdominal pain has proven useful for diagnosis of colorectal carcinoma and IBD (J Clin Gastroenterol, Wolff JH 2008). Albumin, the major plasma protein, is essential for maintaining oncotic pressure in the vascular system. Decreased oncotic pressure allows fluid to leak from interstitial spaces and may be responsible for incidental CWT reported on CT.Aim: To evaluate the association between serum albumin levels and CT findings of CWT.Methods: A total of 325 colonoscopy reports performed for abnormal CT findings of the colon were reviewed from a electronic medical record database from Jan 2006 to Jan 2008. Inclusion criteria for the study population included only CT reports of CWT in patients with corresponding serum albumin levels (normal 3.5-5.0 gm/ dL). Patients were excluded if albumin levels were not drawn within 1 wk of the CT scan and if colonoscopy was not done within 2 days of the CT. Site(s) of CWT, endoscopic findings, and histology were collected. Age matched patients with normal (no CWT) abdominal CT and documented serum albumin levels comprised the control group (n⫽100). Data were compared using t-test or oneway analysis of variance. Significance was set at p ⬍ 0.05 and values are presented as Mean ⫹ SD. Results: A total of 66 patients met inclusion criteria and were included in the study (20 Male, 46 Fem; age 54 yrs). CWT was associated with normal colonoscopy in 24/66 and with abnormal colonoscopy in 42/66. Overall, serum albumin levels were significantly lower in the CWT patients (3.18 ⫹ .9 gm/dL) compared with the control patients (3.80 ⫹ .85 gm/dL) without CWT (P⬍0.001). Serum albumin levels were significantly lower in the CWT groups whether they had abnormal colonoscopy (3.13 ⫹ .90 gm/dL) or normal colonoscopy (3.27 ⫹ .99 gm/dL; P ⬍ 0.001). In patients with abnormal CWT and positive endoscopic findings, 40% (17/42) were found to have a new diagnosis of adenocarcinoma (9) or IBD (8). Conclusion: To our knowledge, these data are the first to demonstrate an association between serum albumin levels and CT findings of CWT. Patients with CWT on CT had significantly lower serum albumin levels compared to control patients without CWT. Tissue edema may explain these findings. Follow up colonoscopy revealed a new diagnosis of

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Abstracts more ominous disease 40% of the time. Although our data suggests that low serum albumin can independently be associated with CWT on CT, our findings also suggest the need for colonoscopy evaluation of these patients.

S1550 Prevalence and Risk Factors for Adenomas in 40-49 Year Old Individuals With a Family History of Colon Cancer Akshay K. Gupta, Jewel Samadder, Eric E. Elliott, Saurabh Sethi, Philip S. Schoenfeld Aim: Per current multi-society colorectal cancer (CRC) guidelines, patients with a first degree relative (FDR) with CRC should get colonoscopy at age 40. Repeat scopes should be performed every 5 yrs if the FDR was diagnosed (dx) with CRC ⬍ 60 yrs, but only every 10yrs if the FDR was dx with CRC ⬎ 60 yrs. No previous study has examined the prevalence of adenomas and advanced adenomas (AA) and risk factors for adenomas in these 40-49 year olds. Methods: For this retrospective database study, inclusion criteria were: (a) 40-49 yr olds who underwent their 1st screening colonoscopy for family history (FH) of CRC in a FDR from 2006-09(cases); and (b) 40-49 yr olds who underwent colonoscopy in 2006-09 for abdominal pain or altered bowel habits (controls). Exclusion criteria: personal history of CRC/adenomas/hereditary CRC syndrome/ IBD, prior colonoscopy, active GI bleeding, iron deficiency anemia, unexplained weight loss ⬎10 pounds. Number of adenomas and AA were quantified. For risk factor analysis, data was extracted about age, gender, ethnicity, age of FDR at dx of CRC, BMI, presence of diabetes, and aspirin/NSAID use. STATA 10.0 was used for statistical analysis.Results: There were 387 individuals in the FH group and 178 in the control group. Demographic data are summarized below. Age at dx of FDR was known in 87% of subjects (336/387). There was no significant difference between cases and controls for prevalence of adenoma [18.6% (72/ 387) vs 13.5% (24/178); p ⫽ 0.13] or AA [4.1% (16/387) vs 3.4% (6/178), p ⫽ 0.67]. Individuals whose FDR was dx with CRC ⱖ 60 years old had more adenomas vs individuals with FDR dx with CRC ⬍ 60 years old [23.8% (40/168) vs 13.7% (23/168), p ⫽ 0.02]. However, on multiple logistic regression, neither (⫹) FH of CRC nor having FDR dx with CRC ⬍ 60 yrs old was independently associated with adenomas. The endoscopist did not follow current recommendations for repeat colonoscopy in 38.9% of cases.Conclusion: In 40-49 yr old individuals, a FH of CRC in a FDR or the age of FDR at the time of diagnosis may not impact the prevalence of adenomas or AA.

Age Sex Race BMI

(ⴙ) FH of CRC

Controls

P

44.5 ⫾ 3.0y M - 43%: F - 57% Caucasian 79% African American (AA) 6% 28 ⫾ 7

44.7 ⫾ 2.6y M - 30%: F - 70% Caucasian 86% AA 6.2% 28 ⫾ 7

0.48 0.005 0.11 0.9

S1551 Epidemiologic Characteristics of Patients With Inflammatory Bowel Disease Undergoing Gastrointestinal Endoscopy Nundhini Thukkani, Luke Williams, Amnon Sonnenberg Aim: The aim of the study was to describe the demographic characteristics of patients with inflammatory bowel disease (IBD) undergoing gastrointestinal endoscopy. Methods: The Clinical Outcomes Research Initiative (CORI) maintains a database of endoscopic procedures in diverse clinical practices distributed throughout the United States. The data from 2000-2007 were used to analyze the demographic characteristics of patients with Crohn’s disease (CD) and ulcerative colitis (UC). Case and control subjects were compared using the Mantel-Haenszel procedure to calculate adjusted odds ratios (OR) and their 95% confidence intervals. Other comparisons were based on Student’s t-test or linear regression analysis. The method of direct standardization was applied to adjust proportional CD or UC rates of individual US regions to the underlying differences in the age, sex, and race distributions of their populations.Results: During the period 20002007, 4631 patients with CD and 6619 patients with UC were compared to a control population of 826,207 patients without IBD. CD and UC patients were significantly (p ⬍ 0.0001) younger than controls: 41.7 ⫾ 18.4, 47.3 ⫾ 17.4, 59.2 ⫾ 14.0 years, respectively. CD and UC were less common among nonwhite than white endoscopy patients: OR⫽0.64 (0.58-0.70) for CD and OR⫽0.71 (0.660.77) for UC. Endoscopy for IBD was only slightly less common among female than male CD patients (0.94, 0.89-1.00), but significantly less common among female than male UC patients (0.72, 0.68-0.75). Compared with community/ private practices, relatively more endoscopies were performed among IBD patients in academic institutions: OR⫽1.68 (1.56-1.81) for CD and OR⫽1.27 (1.19-1.36) for UC. There was a similar trend for UC patients in VA hospitals: OR⫽0.95 (0.87-1.03) for CD and OR⫽1.14 (1.02-1.27) for UC. The race-, sex-, and age-adjusted rates of CD and UC were both significantly higher in the northern than southern regions of the US, with a significant correlation of r⫽0.89, df⫽4, p⫽0.017 between the geographic distributions of the two diagnoses.Conclusions: The endoscopy patterns of IBD patients may be influenced in part by the underlying epidemiology of these two diagnoses, with

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CD and UC being more common among younger patients, whites compared to nonwhites, and patients from northern regions of the US. Relatively more IBDrelated endoscopies occur in university and VA hospitals than in private/ community practice.

S1552 A Comparison of Lower Gastrointestinal (GI) Bleeding and Screening Colonoscopy Patient Cohorts: Data From the CORI National Endoscopic Database Ian M. Gralnek, Glenn M. Eisen, Jennifer L. Holub Background: There are limited data describing patients (pts) presenting with acute lower GI bleeding (LGIB) who undergo colonoscopy. There are no comparative data with patient populations undergoing colonoscopy for alternative indications. Aims / Methods: To compare a cohort of pts presenting with LGIB to pts undergoing screening colonoscopy. We analyzed data from a large consortium of diverse gastroenterology practices in the US using the Clinical Outcomes Research Initiative National Endoscopic Database (CORINED). The CORI-NED represents endoscopies for multiple indications and has been shown to reflect everyday endoscopic practice. We identified all adult pts (⬎⫽18 years) over a seven-year period, from 1/02 to 12/08, who underwent colonoscopy for either hematochezia or screening. We characterized and compared these distinct cohorts by patient demographics, disease co-morbidity, practice setting, endoscopic diagnosis, extent of exam, and adverse events.Results: We identified n⫽76,928 persons who underwent colonoscopy for hematochezia and n⫽234,333 who had colonoscopy for screening. As compared to the screening cohort, the LGIB pts were significantly younger p⬍0.0001, had significantly fewer females (42.9% vs 46.7%), were more likely to be non-White (p⬍0.0001) and the vast majority were evaluated in community practice n⫽60,290 (78.4%). Significantly more of the LGIB cohort (7.5% vs 3.5%, p⬍0.0001) were defined as having a high-risk ASA score (ASA Score ⫽ III or IV). As compared to the endoscopic findings* in the screening colonoscopy cohort, the LGIB cohort had significantly higher rates of hemorrhoids 63.8% vs 37.5%, mucosal abnormality / colitis 7.8% vs 1.3%, tumors 2.0% vs 0.4%, and angiodysplasia 1.2% vs 0.6% (all p⬍0.0001). Yet, significantly lower rates of diverticulosis 38.3% vs 43.1% and polyp or multiple polyps 38.5% vs 45.4%, (all p⬍0.0001). In the LGIB cohort, significantly fewer colonoscopies reached the cecum 94.8% vs 97.2% p⬍0.0001, serious adverse events were no different, p⫽NS.Conclusions: As compared to a screening colonoscopy cohort, pts with LGIB presenting with hematochezia who undergo colonoscopy are more likely to be male, non-White, have significantly higher ASA score, and more likely to have hemorrhoids, mucosal abnormalities / colitis, tumors, or angiodysplasia to explain the LGIB. In addition, there were significantly higher rates of incomplete colonoscopy in the LGIB cohort. These comparative data provide an important snap-shot view between a LGIB cohort and screening colonoscopy cohort as seen in community practice. *Pts may have had more than one endoscopic finding reported at colonoscopy.

S1553 Endoscopic Submucosal Dissection Versus Laparoscopic Resection for Early Colorectal Neoplasms: A Case-Control Study Tiffany C. Wong, Philip W. Chiu, Simon S. Ng, Wai Keung Leung, Janet F. Lee, Enders K. Ng, James Y. Lau, Francis K. Chan Background: The standard treatment for large colorectal neoplasms that are not amenable to complete endoscopic removal is laparoscopic resection. Endoscopic submucosal dissection (ESD) has been recently introduced as a novel procedure that enables en bloc resection of large colorectal neoplasms. To date, no report can be found in the literature comparing ESD and laparoscopic resection for treating early colorectal neoplasms. Objective: To compare the short-term clinical outcomes of ESD versus laparoscopic resection for early colorectal neoplasms that are not amenable to en bloc endoscopic resection with conventional techniques.Methods: Between January 2006 and June 2009, 31 patients diagnosed with early colorectal neoplasms (⭌2 cm in size and without endoscopic signs of massive submucosal invasion) that were deemed not feasible for en bloc endoscopic resection with conventional techniques underwent 33 ESDs. They were compared with a historical cohort (control group) of 28 patients with early colorectal neoplasms who underwent laparoscopic resection. Controls were matched for age, sex, and characteristics of the neoplasms, including site, size, and pathology. Short-term clinical outcomes including post-procedure recovery and morbidity were compared between the two groups.Results: ESD was successfully accomplished in 29 out of the 33 procedures (87.9%). In the ESD group, the mean size of the neoplasms was 2.2⫾0.18 cm, and the mean procedure time was 96 min (range, 40-108 min). En bloc resection was achieved in 27 ESD procedures (81.8%). Perforation occurred in 3 out of the 29 accomplished ESD procedures (10.3%), and all were successfully managed with endoscopic clipping. The laparoscopic group had a short-term morbidity rate of 35.7%. One patient developed anastomotic leak after laparoscopic resection and required reoperation. Comparing with the laparoscopic group, the ESD group

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