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Sa1521 Endoscopic Large-Balloon Sphincteroplasty Without Preceding Sphincterotomy Versus Endoscopic Sphincterotomy Plus Large-Balloon Sphincteroplasty for the Removal of Large Bile Duct Stones: A Retrospective Cross-Sectional Study
Abstracts
success rate (p⬍0.01), but not with the complication rate.The 35 patients whose ERCP was unsuccessful underwent: percutaneous transhepatic biliary drainage (PTBD) in 18 cases (51.4%); medical treatment and radiological follow-up in 11 (31.4%); and surgery in 6 (17.2%). PTBD carried a 22.2% rate of infectious/ bleeding complications. Conclusion: Papilla precutting is useful in deep duct cannulation, with an acceptable complication rate, although the method is operator-dependent.
Group A within first 36 hours, in Group B after 72 hours. The data of age, sex, leucocyte levels before treatment, the falling time of leucocyte and duration of hospital stay were recorded and analised in SPSS 17.0 version. The mean values were calculated due to Mann-Whitney U and Chi-square tests. There were 46 male and 68 female patients. ERCP was performed to 63 patients within first 36 hours (Group A) and 51 patients afer 72 hours of application (Group B). There was no statistical difference of the number stones in the choledochus and diameter of the choledochus between two groups. Three patients in Group A and 1 patient in Group B were died from sepsis. The mean age was 68⫾15 years, leucocyte count was 17⫾5,8 /mm3, the mean day of leucocyte count turning into normal level was 4,3⫾4,1 days, number of days antibiotics used were 5,4⫾ 2,8 days, the duration of hospital stay was 6,2⫾4,7 days in Group A. The mean age was 70⫾13 years, leucocyte count was 17⫾6,7 /mm3, the mean day of leucocyte count turning into normal level was 5,3⫾2,6 days, number of days antibiotics used were 7,2⫾3,1 days, the duration of hospital stay was 9,2⫾4,6 days in Group B. There were significant difference on duration of hospital stay, leucocyte decreasing time and the days of antibiotics used between two groups. There was no bleeding, perforation and bacterial septicemia in each group during and after ERCP. According to our results, clinical recovery is provided in a shorter time in early ERCP applied patients. This situation reduces the duration of hospital stay and number of days of antibiotics used. Early ERCP has no significant effect on mortality and morbidity.
Success rate of precutting by grade of difficulty of the ERCP and by operator (the number of patients is indicated at the top of each column)
Sa1519 Carbon Dioxide Insufflation Versus Conventional Saline Irrigation for PerOral Video Cholangioscopy Shinpei Doi1, Ichiro Yasuda1, Masanori Nakashima1, Takuji Iwashita1, Katsuhisa Toda1, Tsuyoshi Mukai2, Keisuke Iwata2, Hisataka Moriwaki1 1 First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan; 2Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan Background: Recent studies have evaluated the efficacy of peroral cholangioscopy (POCS) for diagnosis of biliary diseases. During POCS, saline is irrigated to replace yellow bile. In order to obtain clear images, a lengthy saline irrigation is required. Aim: To evaluate the feasibility of replacing saline irrigation with CO2insufflation during POCS. Methods: We enrolled 36 patients with bile duct lesions for POCS. Among these, 18 patients underwent POCS using saline irrigation followed by CO2 insufflation, while the remaining 18 patients received the reverse approach. We compared the time required to obtain a clear endoscopic image as well as the quality of the images. Results: The time required to obtain a clear endoscopic image in CO2insufflation (4 min) was significantly shorter than that in saline irrigation (24 min, p ⬍ 0.001). The quality of the endoscopic images obtained was similar in 27 cases. However, CO2 insufflation provided better images in 4 cases that showed an abundance of mucin or biliary sludge. In contrast, saline irrigation was superior to CO2 insufflation in 5 cases that showed severe stricture with bleeding and tall papillary lesions. Conclusions: CO2insufflation during POCS can reduce procedure time and simplify cholangioscopy. Overall image quality was similar to the conventional saline irrigation.
Sa1520 Early ERCP Is Safe and Cost-Effective in the Treatment of Mild to Moderate Acute Cholangitis Emrah Alper2, Belkis Unsal2, Zafer Buyraç2, BehlüL Baydar1, Fatih Aslan2, Serdar Akça1, Yucel Ustundag3 1 Gastroenterology and Surgery, Memorial Antalya Hospital, Antalya, Turkey; 2Gastroenterology, Ataturk Training and Research Hospital, Izmir, Turkey; 3Gastroenterology, Karaelmas University, Zonguldak, Turkey Acute cholangitis has high mortality and morbidity if left untreated. Acute cholangitis can be treated effectively with biliary decompression and antibiotics. But the timing of biliary decompression is still unclear. Aim is to analize the effect of early ERCP on duration of hospital stay, antibiotic use, mortality and morbidity of the patients with mild to moderate acute cholangitis. The study is done prospectively in a gastroenterology clinic in a tertier center. One hundred and fourteen acute cholangitis patients diagnosed with laboratory and screening methods applied with Charcoat triad were included in the study between May 2008 and May 2010. The patients randomly divided into two groups. Wide spectrum antibiotics were initiated to all patients in their first application. Under anestesia, the ERCP was performed with standard Olympus duodenoscope in
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Sa1521 Endoscopic Large-Balloon Sphincteroplasty Without Preceding Sphincterotomy Versus Endoscopic Sphincterotomy Plus LargeBalloon Sphincteroplasty for the Removal of Large Bile Duct Stones: A Retrospective Cross-Sectional Study Jin Hong Kim, Jae Chul Hwang, Byung Moo Yoo, Sun Gyo Lim, Sung Jae Shin, Kee Myung Lee Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea Background and Aim: Recently, several studies have been reported in which large-balloon sphincteroplasty (LBS) was conducted for the removal of large bile duct stones. Endoscopic sphincterotomy (EST) is usually performed before LBS because of the high risk of pancreatitis. The aim of this study was to compare the therapeutic effectiveness and complications between LBS without preceding EST and EST plus LBS for the treatment of large bile duct stones. Patients and Methods: Fifty three patients (M:F ⫽ 18:35, mean age 69.6) with large bile duct stones (ⱖ 12mm) had LBS without preceding EST from March 2008 to April 2009. Seventy patients (M:F ⫽ 33:37, mean age 68.2) with large bile duct stones who underwent EST plus LBS between July 2005 and February 2008, served as a historical control. Balloon sphincteroplasty was done with a 12- to 20-mm diameter balloon. After ballooning for 1minute, stone removal was done with a basket or a retrieval balloon. If stone removal failed with standard methods, endoscopic mechanical lithotripsy (EML) was performed. Efficacy of stone removal and complications related to the procedure were analyzed. Results: LBS without EST compared with EST plus LBS resulted in similar outcomes in terms of overall successful stone removal (96.2% vs. 95.7, P ⫽ 0.887), mean transverse stone diameter in the success group (15.4mm vs. 16.2mm, P ⫽ 0.254), and the use of EML (15.1% vs. 24.3%, P ⫽ 0.261). Complications were as follows for the LBS without EST group and the EST plus LBS group: pancreatitis (7.5% vs. 5.7%, P ⫽ 0.725); impaction of the basket and stone (0% vs. 1.4%, P ⫽ 1.000), and perforation (0% vs. 2.9%, P ⫽ 0.506). There was one death due to pancreatitis and perforation in the EST plus LBS group. Conclusions: LBS without a preceding EST showed no significant complications and resulted similar to those with EST plus LBS for the removal of large bile duct stones. Therefore, LBS without EST could be an effective alternative for the treatment of large bile duct stones. Prospective, large-scale, randomized, comparative studies are needed to support our study.
Sa1522 Neosquamous Epithelium After Radiofrequency and Cryoablation of Barrett’s Esophagus Displays Genetic Abnormalities: FISH Analysis Sofiya Reicher1, Fatih Z. Boyar3, Vivek S. Ramanathan1, Patricia Chan3, Vladimira Sulcova3, Samuel W. French2, David S. Chung1, Binh V. Pham1, Viktor E. Eysselein1, Arturo L. Anguiano3 1 Gastroenterology, Harbor-UCLA Medical Center, Torrance, CA; 2 Pathology, Harbor-UCLA Medical Center, Torrance, CA; 3Quest Diagnostics Nichols Institute, San Juan Capistrano, CA Background & Aim: Barrett’s esophagus (BE) progression to cancer is associated with accumulation of genetic abnormalities. Recently, promising ablative techniques such as radiofrequency ablation (RFA) and cryoablation have been increasingly applied for BE eradication. Our study aimed to evaluate chromosomal changes in BE before and after RFA and cryoablation by using
Volume 73, No. 4S : 2011
GASTROINTESTINAL ENDOSCOPY
AB195
success rate (p⬍0.01), but not with the complication rate.The 35 patients whose ERCP was unsuccessful underwent: percutaneous transhepatic biliary drainage (PTBD) in 18 cases (51.4%); medical treatment and radiological follow-up in 11 (31.4%); and surgery in 6 (17.2%). PTBD carried a 22.2% rate of infectious/ bleeding complications. Conclusion: Papilla precutting is useful in deep duct cannulation, with an acceptable complication rate, although the method is operator-dependent.
Group A within first 36 hours, in Group B after 72 hours. The data of age, sex, leucocyte levels before treatment, the falling time of leucocyte and duration of hospital stay were recorded and analised in SPSS 17.0 version. The mean values were calculated due to Mann-Whitney U and Chi-square tests. There were 46 male and 68 female patients. ERCP was performed to 63 patients within first 36 hours (Group A) and 51 patients afer 72 hours of application (Group B). There was no statistical difference of the number stones in the choledochus and diameter of the choledochus between two groups. Three patients in Group A and 1 patient in Group B were died from sepsis. The mean age was 68⫾15 years, leucocyte count was 17⫾5,8 /mm3, the mean day of leucocyte count turning into normal level was 4,3⫾4,1 days, number of days antibiotics used were 5,4⫾ 2,8 days, the duration of hospital stay was 6,2⫾4,7 days in Group A. The mean age was 70⫾13 years, leucocyte count was 17⫾6,7 /mm3, the mean day of leucocyte count turning into normal level was 5,3⫾2,6 days, number of days antibiotics used were 7,2⫾3,1 days, the duration of hospital stay was 9,2⫾4,6 days in Group B. There were significant difference on duration of hospital stay, leucocyte decreasing time and the days of antibiotics used between two groups. There was no bleeding, perforation and bacterial septicemia in each group during and after ERCP. According to our results, clinical recovery is provided in a shorter time in early ERCP applied patients. This situation reduces the duration of hospital stay and number of days of antibiotics used. Early ERCP has no significant effect on mortality and morbidity.
Success rate of precutting by grade of difficulty of the ERCP and by operator (the number of patients is indicated at the top of each column)
Sa1519 Carbon Dioxide Insufflation Versus Conventional Saline Irrigation for PerOral Video Cholangioscopy Shinpei Doi1, Ichiro Yasuda1, Masanori Nakashima1, Takuji Iwashita1, Katsuhisa Toda1, Tsuyoshi Mukai2, Keisuke Iwata2, Hisataka Moriwaki1 1 First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan; 2Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan Background: Recent studies have evaluated the efficacy of peroral cholangioscopy (POCS) for diagnosis of biliary diseases. During POCS, saline is irrigated to replace yellow bile. In order to obtain clear images, a lengthy saline irrigation is required. Aim: To evaluate the feasibility of replacing saline irrigation with CO2insufflation during POCS. Methods: We enrolled 36 patients with bile duct lesions for POCS. Among these, 18 patients underwent POCS using saline irrigation followed by CO2 insufflation, while the remaining 18 patients received the reverse approach. We compared the time required to obtain a clear endoscopic image as well as the quality of the images. Results: The time required to obtain a clear endoscopic image in CO2insufflation (4 min) was significantly shorter than that in saline irrigation (24 min, p ⬍ 0.001). The quality of the endoscopic images obtained was similar in 27 cases. However, CO2 insufflation provided better images in 4 cases that showed an abundance of mucin or biliary sludge. In contrast, saline irrigation was superior to CO2 insufflation in 5 cases that showed severe stricture with bleeding and tall papillary lesions. Conclusions: CO2insufflation during POCS can reduce procedure time and simplify cholangioscopy. Overall image quality was similar to the conventional saline irrigation.
Sa1520 Early ERCP Is Safe and Cost-Effective in the Treatment of Mild to Moderate Acute Cholangitis Emrah Alper2, Belkis Unsal2, Zafer Buyraç2, BehlüL Baydar1, Fatih Aslan2, Serdar Akça1, Yucel Ustundag3 1 Gastroenterology and Surgery, Memorial Antalya Hospital, Antalya, Turkey; 2Gastroenterology, Ataturk Training and Research Hospital, Izmir, Turkey; 3Gastroenterology, Karaelmas University, Zonguldak, Turkey Acute cholangitis has high mortality and morbidity if left untreated. Acute cholangitis can be treated effectively with biliary decompression and antibiotics. But the timing of biliary decompression is still unclear. Aim is to analize the effect of early ERCP on duration of hospital stay, antibiotic use, mortality and morbidity of the patients with mild to moderate acute cholangitis. The study is done prospectively in a gastroenterology clinic in a tertier center. One hundred and fourteen acute cholangitis patients diagnosed with laboratory and screening methods applied with Charcoat triad were included in the study between May 2008 and May 2010. The patients randomly divided into two groups. Wide spectrum antibiotics were initiated to all patients in their first application. Under anestesia, the ERCP was performed with standard Olympus duodenoscope in
www.giejournal.org
Sa1521 Endoscopic Large-Balloon Sphincteroplasty Without Preceding Sphincterotomy Versus Endoscopic Sphincterotomy Plus LargeBalloon Sphincteroplasty for the Removal of Large Bile Duct Stones: A Retrospective Cross-Sectional Study Jin Hong Kim, Jae Chul Hwang, Byung Moo Yoo, Sun Gyo Lim, Sung Jae Shin, Kee Myung Lee Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea Background and Aim: Recently, several studies have been reported in which large-balloon sphincteroplasty (LBS) was conducted for the removal of large bile duct stones. Endoscopic sphincterotomy (EST) is usually performed before LBS because of the high risk of pancreatitis. The aim of this study was to compare the therapeutic effectiveness and complications between LBS without preceding EST and EST plus LBS for the treatment of large bile duct stones. Patients and Methods: Fifty three patients (M:F ⫽ 18:35, mean age 69.6) with large bile duct stones (ⱖ 12mm) had LBS without preceding EST from March 2008 to April 2009. Seventy patients (M:F ⫽ 33:37, mean age 68.2) with large bile duct stones who underwent EST plus LBS between July 2005 and February 2008, served as a historical control. Balloon sphincteroplasty was done with a 12- to 20-mm diameter balloon. After ballooning for 1minute, stone removal was done with a basket or a retrieval balloon. If stone removal failed with standard methods, endoscopic mechanical lithotripsy (EML) was performed. Efficacy of stone removal and complications related to the procedure were analyzed. Results: LBS without EST compared with EST plus LBS resulted in similar outcomes in terms of overall successful stone removal (96.2% vs. 95.7, P ⫽ 0.887), mean transverse stone diameter in the success group (15.4mm vs. 16.2mm, P ⫽ 0.254), and the use of EML (15.1% vs. 24.3%, P ⫽ 0.261). Complications were as follows for the LBS without EST group and the EST plus LBS group: pancreatitis (7.5% vs. 5.7%, P ⫽ 0.725); impaction of the basket and stone (0% vs. 1.4%, P ⫽ 1.000), and perforation (0% vs. 2.9%, P ⫽ 0.506). There was one death due to pancreatitis and perforation in the EST plus LBS group. Conclusions: LBS without a preceding EST showed no significant complications and resulted similar to those with EST plus LBS for the removal of large bile duct stones. Therefore, LBS without EST could be an effective alternative for the treatment of large bile duct stones. Prospective, large-scale, randomized, comparative studies are needed to support our study.
Sa1522 Neosquamous Epithelium After Radiofrequency and Cryoablation of Barrett’s Esophagus Displays Genetic Abnormalities: FISH Analysis Sofiya Reicher1, Fatih Z. Boyar3, Vivek S. Ramanathan1, Patricia Chan3, Vladimira Sulcova3, Samuel W. French2, David S. Chung1, Binh V. Pham1, Viktor E. Eysselein1, Arturo L. Anguiano3 1 Gastroenterology, Harbor-UCLA Medical Center, Torrance, CA; 2 Pathology, Harbor-UCLA Medical Center, Torrance, CA; 3Quest Diagnostics Nichols Institute, San Juan Capistrano, CA Background & Aim: Barrett’s esophagus (BE) progression to cancer is associated with accumulation of genetic abnormalities. Recently, promising ablative techniques such as radiofrequency ablation (RFA) and cryoablation have been increasingly applied for BE eradication. Our study aimed to evaluate chromosomal changes in BE before and after RFA and cryoablation by using
Volume 73, No. 4S : 2011
GASTROINTESTINAL ENDOSCOPY
AB195