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Sa1584 Using a Gastroscope for an Incomplete Colonoscopy in Patients With Stricturing Crohn's Disease
Abstracts
estimation by gross findings only. The agreement of submucosal invasion by pit pattern or microvascular pattern is substantial.
Diagnostic accuracy for submucosal invasion
Agreement on submucosal invasion (Fleiss’ Kappa)
Doctor A B C A-B-C Gross finding 67% 76% 82% 0.564 Pit pattern 85% 88% 85% 0.673 Microvascular pattern 88%* 85% 88% 0.673 *Comparison of diagnostic accuracy between gross finding and microvascular pattern (p⬍0.05).
Sa1584 Using a Gastroscope for an Incomplete Colonoscopy in Patients With Stricturing Crohn’s Disease Soo Young Na, Kyung Jo Kim, Dong-Hoon Yang, Kee Wook Jung, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Jin Ho Kim Gastroenterology, Asan Medical Center, Seoul, Republic of Korea Background/Aims: Colonoscopy is performed in patients with Crohn’s disease (CD) for estimating disease activity. However, colonoscopic examination is often incomplete in CD patients because of colon stricture. This study was conducted to evaluate the additional role of using a gastroscope in CD patients who failed colonoscopy due to stricture. Methods: Among 1501 CD patients who had been registered in Asan Medical Center from January 1991 through December 2009, we enrolled 76 patients who had failed complete colonoscopy due to stricture. In 76 patients, 101 colonoscopies were performed with gastroscope to complete the examination. Complete colonoscopy was defined as evaluation up to cecum or anastomotic site of the ileo-cecal or colon resection. Results: The patients were composed of 36 (47.3%) men and 40 women. The age at diagnosis of CD ranged from 17 to 40 years in 60 (78.9%) of 76 patients. Mean disease duration of 101 cases at using a gastroscope for colonoscopy (GFC) was 6.8 ⫾ 4.7 (0 19.2) years. The most common reason for examination was surveillance (63.3%). About a half of cases had a history of peri-anal disease (56.4%) and bowel surgery (47.5%). The mean CDAI and CRP at using a GFC were 198 ⫾ 101 (2 466) and 1.7 ⫾ 1.9 (0 - 10.0) mg/dL, respectively. In majority of the cases, 5-ASA, antibiotics, corticosteroids, and immunosuppressants had been administered before using a GFC, and 5-ASA and immunosuppressants at using a GFC. The levels of failed colonoscopies were anus in 35 (34.7%) of 101 cases, rectum in 34 (33.7%), sigmoid colon in 27 (26.7%), descending colon in 3 (3.0%), transverse colon in 1 (1.0%), and ascending colon in 1 (1.0%), respectively. Complete examinations with GFC were possible in 71 (70.3%) of 101 cases, and we were able to evaluate more proximal portion with GFC than colonoscopy in 18 cases. Totally, additional evaluation was given through GFC in 89 (88.1%) of 101 cases. No complications occurred after using a GFC. We found active lesions in 55 (61.8%) of 89 cases; aphthous ulcers in 5 (5.6%), medium sized ulcers in 22 (24.7%), large, longitudinal or serpiginous ulcers in 27 (30.3%), and one (1.1%) rectal cancer with biopsy, respectively. After using a GFC, 33 (37.1%) of 89 cases changed medications. Conclusion: In CD patients with incomplete colonoscopy due to stricture, using a GFC could evaluate the whole colon in about 70% of cases. Furthermore, it provided an additional information on disease state in about 90% of cases. By using a GFC, we could confirm active lesions in about 60% of cases and a cancer. These findings suggest that using a gastroscope for an incomplete colonoscopy should be considered in patients with structuring CD.
Sa1585 Diagnostic Yield of Complete Colon Evaluation After Initial Incomplete Colonoscopy: A Comparison of Repeat Colonoscopy Versus Barium Enema Sean T. McCarthy, Vineel Kankanala, Andrew Gawron, Rajesh N. Keswani Medicine, Northwestern University, Chicago, IL Introduction: Incomplete colonoscopy occurs frequently in clinical practice. After incomplete colonoscopy, complete colon evaluation (CCE) can be performed via repeat endoscopic attempts or radiologic means. However, data on the yield of CCE after incomplete colonoscopy is scant. Methods: The Northwestern Medicine Enterprise Data Warehouse was queried for patients with a suspected incomplete colonoscopy using free text search criteria during the time period of January 1, 2004- May 1, 2004. Procedure notes were manually reviewed to confirm that colonoscopy was incomplete and all follow-up testing was reviewed to determine the frequency and yield of follow-up testing. Results: In total, 121
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patients (mean age 66.1y, 82F/39M) underwent at least one incomplete colonoscopy during the 4-month time period. The majority of patients were over age 50 (n⫽108) and/or undergoing colonoscopy for polyp/cancer detection (n⫽112). Procedures were performed by 22 unique endoscopists (range 1-18 incomplete procedures per physician). The most common indications for colonoscopy were screening (21.5%) and evaluation of gastrointestinal bleeding (19.8%). Polyps were identified on initial exam in 19 incomplete procedures. Of the 121 patients with incomplete examination, 83 patients (68.6%) underwent CCE during the five-year follow-up period, with 72 patients (59.5%) undergoing follow-up within 1 year. Of these 72 patients, initial attempt at CCE was most commonly performed with barium enema (n⫽44) or repeat colonoscopy (n⫽20), utilizing extended bowel preparation or anesthesia assistance in select cases. In the 44 patients undergoing CCE with barium enema, the study was characterized as “limited” in 24 (54.5%). A new colon polyp was seen in a single patient (2.3%), with this polyp removed at subsequent complete colonoscopy. In the 20 patients with attempted CCE via repeat colonoscopy, complete examination was not performed in 5 patients. Of the remaining 15 patients, 5 had new colon polyps on this second colonoscopy including one additional colorectal cancer. Polyp detection rate was significantly greater utilizing colonoscopy versus barium enema (33% vs. 2.3%, p ⬍ .01). There were no new colorectal cancers detected at 5-year follow-up. Conclusions: The majority of barium enema examinations performed after incomplete colonoscopy are limited in the detection of small polyps. Repeat colonoscopy is successful in the majority of patients and the polyp detection rate is significantly greater than barium enema. When possible, a repeat attempt at colonoscopy should be considered in patients with a history of a prior incomplete procedure.
Sa1586 Evaluation of Healing Process of Artificial Ulcers in Colorectum After Endoscopic Submucosal Dissection Yukako Nemoto, Koichiro Sato, Sayo Ito, Iruru Maetani Division of Gastroenterology, Daprtment of Medicine, Toho University Ohashi Medical Center, Tokyo, Japan Background and Aim: Endoscopic submucosal dissection (ESD) is recently developed as a method of endoscopic resection, characterized by circumferential mucosal incision and submucosal dissection of the lesion. Since ESD enables en bloc resection of large lesions in any part of the gastrointestinal tract, it has been applied to many larger lesions resulting in the creation of larger artificial ulcers. In a previous endoscopic study, that gastric ulcers artificially created by ESD may heal within 8 weeks, regardless of size and location was reported. The present study was designed to evaluate the quality of post-ESD ulcer healing by endoscopy. Materials and Methods: We evaluated the 24 post-ESD colorectal ulcers using endoscopy post 4 weeks, in 24 patients, sixteen men and eight women, a mean age of 69.8 year, who underwent ESD between January 2008 and October 2010. Endoscopic observation parameters included ulcer location, and healing stage. The locations of ulcers were 4 of cecum, 5 of ascending, 4 of transverse, 1 of descending, 3 of sigmoid, and 7 of rectum. There were eleven cases of carcinoma in adenoma and thirteen cases of adenoma. The eight postESD ulcers that have not healed within 4 weeks were examined again after 8 weeks. Results: All post-ESD ulcers healed within 8 weeks. In ulcers healed within 4 weeks (early healing group), the mean size of specimens was 36.1 mm (long-axis). In ulcers required more than 4 weeks to heal (late healing group), the mean size of specimens was 48.1 mm. A mean size of the resected specimen was significantly different between early healing group and late healing group. The locations of ulcers were not significantly different in two groups. Conclusions: Colorectal ulcers artificially created by ESD heal within 8 weeks, regardless of size and location. The larger size of specimen will take longer time to heal.
Sa1587 Is the Prevalence of Colorectal Adenoma Higher in Patients With Gastric Neoplasm? Chang Hwan Choi, Sang Pyo Han, Bong Ki Cha, Beom Jin Kim, Hyoung-Chul Oh, Jeong Wook Kim, Jae Hyuk Do, Jae G. Kim, Se Kyung Chang Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea Background & Aims: Colorectal cancer is more frequently detected among primary gastric cancer patients. We aimed to compare the prevalence of colorectal adenomas between patients with gastric neoplasm and healthy controls. Methods: This study was retrospectively performed in Chung-Ang University Hospital from January 2005 through June 2010. A total of 172 patients with gastric neoplasm who underwent colonoscopy were enrolled. Age and sex matched 860 subjects without gastric neoplasm who underwent colonoscopy in health promotion center were enrolled as the controls. Various factors were evaluated such as gender, age, body mass index (BMI), abdominal circumference, and the frequency of multiple (ⱖ2 sites), large (ⱖ1cm) and
Volume 73, No. 4S : 2011
GASTROINTESTINAL ENDOSCOPY
AB215
estimation by gross findings only. The agreement of submucosal invasion by pit pattern or microvascular pattern is substantial.
Diagnostic accuracy for submucosal invasion
Agreement on submucosal invasion (Fleiss’ Kappa)
Doctor A B C A-B-C Gross finding 67% 76% 82% 0.564 Pit pattern 85% 88% 85% 0.673 Microvascular pattern 88%* 85% 88% 0.673 *Comparison of diagnostic accuracy between gross finding and microvascular pattern (p⬍0.05).
Sa1584 Using a Gastroscope for an Incomplete Colonoscopy in Patients With Stricturing Crohn’s Disease Soo Young Na, Kyung Jo Kim, Dong-Hoon Yang, Kee Wook Jung, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Jin Ho Kim Gastroenterology, Asan Medical Center, Seoul, Republic of Korea Background/Aims: Colonoscopy is performed in patients with Crohn’s disease (CD) for estimating disease activity. However, colonoscopic examination is often incomplete in CD patients because of colon stricture. This study was conducted to evaluate the additional role of using a gastroscope in CD patients who failed colonoscopy due to stricture. Methods: Among 1501 CD patients who had been registered in Asan Medical Center from January 1991 through December 2009, we enrolled 76 patients who had failed complete colonoscopy due to stricture. In 76 patients, 101 colonoscopies were performed with gastroscope to complete the examination. Complete colonoscopy was defined as evaluation up to cecum or anastomotic site of the ileo-cecal or colon resection. Results: The patients were composed of 36 (47.3%) men and 40 women. The age at diagnosis of CD ranged from 17 to 40 years in 60 (78.9%) of 76 patients. Mean disease duration of 101 cases at using a gastroscope for colonoscopy (GFC) was 6.8 ⫾ 4.7 (0 19.2) years. The most common reason for examination was surveillance (63.3%). About a half of cases had a history of peri-anal disease (56.4%) and bowel surgery (47.5%). The mean CDAI and CRP at using a GFC were 198 ⫾ 101 (2 466) and 1.7 ⫾ 1.9 (0 - 10.0) mg/dL, respectively. In majority of the cases, 5-ASA, antibiotics, corticosteroids, and immunosuppressants had been administered before using a GFC, and 5-ASA and immunosuppressants at using a GFC. The levels of failed colonoscopies were anus in 35 (34.7%) of 101 cases, rectum in 34 (33.7%), sigmoid colon in 27 (26.7%), descending colon in 3 (3.0%), transverse colon in 1 (1.0%), and ascending colon in 1 (1.0%), respectively. Complete examinations with GFC were possible in 71 (70.3%) of 101 cases, and we were able to evaluate more proximal portion with GFC than colonoscopy in 18 cases. Totally, additional evaluation was given through GFC in 89 (88.1%) of 101 cases. No complications occurred after using a GFC. We found active lesions in 55 (61.8%) of 89 cases; aphthous ulcers in 5 (5.6%), medium sized ulcers in 22 (24.7%), large, longitudinal or serpiginous ulcers in 27 (30.3%), and one (1.1%) rectal cancer with biopsy, respectively. After using a GFC, 33 (37.1%) of 89 cases changed medications. Conclusion: In CD patients with incomplete colonoscopy due to stricture, using a GFC could evaluate the whole colon in about 70% of cases. Furthermore, it provided an additional information on disease state in about 90% of cases. By using a GFC, we could confirm active lesions in about 60% of cases and a cancer. These findings suggest that using a gastroscope for an incomplete colonoscopy should be considered in patients with structuring CD.
Sa1585 Diagnostic Yield of Complete Colon Evaluation After Initial Incomplete Colonoscopy: A Comparison of Repeat Colonoscopy Versus Barium Enema Sean T. McCarthy, Vineel Kankanala, Andrew Gawron, Rajesh N. Keswani Medicine, Northwestern University, Chicago, IL Introduction: Incomplete colonoscopy occurs frequently in clinical practice. After incomplete colonoscopy, complete colon evaluation (CCE) can be performed via repeat endoscopic attempts or radiologic means. However, data on the yield of CCE after incomplete colonoscopy is scant. Methods: The Northwestern Medicine Enterprise Data Warehouse was queried for patients with a suspected incomplete colonoscopy using free text search criteria during the time period of January 1, 2004- May 1, 2004. Procedure notes were manually reviewed to confirm that colonoscopy was incomplete and all follow-up testing was reviewed to determine the frequency and yield of follow-up testing. Results: In total, 121
www.giejournal.org
patients (mean age 66.1y, 82F/39M) underwent at least one incomplete colonoscopy during the 4-month time period. The majority of patients were over age 50 (n⫽108) and/or undergoing colonoscopy for polyp/cancer detection (n⫽112). Procedures were performed by 22 unique endoscopists (range 1-18 incomplete procedures per physician). The most common indications for colonoscopy were screening (21.5%) and evaluation of gastrointestinal bleeding (19.8%). Polyps were identified on initial exam in 19 incomplete procedures. Of the 121 patients with incomplete examination, 83 patients (68.6%) underwent CCE during the five-year follow-up period, with 72 patients (59.5%) undergoing follow-up within 1 year. Of these 72 patients, initial attempt at CCE was most commonly performed with barium enema (n⫽44) or repeat colonoscopy (n⫽20), utilizing extended bowel preparation or anesthesia assistance in select cases. In the 44 patients undergoing CCE with barium enema, the study was characterized as “limited” in 24 (54.5%). A new colon polyp was seen in a single patient (2.3%), with this polyp removed at subsequent complete colonoscopy. In the 20 patients with attempted CCE via repeat colonoscopy, complete examination was not performed in 5 patients. Of the remaining 15 patients, 5 had new colon polyps on this second colonoscopy including one additional colorectal cancer. Polyp detection rate was significantly greater utilizing colonoscopy versus barium enema (33% vs. 2.3%, p ⬍ .01). There were no new colorectal cancers detected at 5-year follow-up. Conclusions: The majority of barium enema examinations performed after incomplete colonoscopy are limited in the detection of small polyps. Repeat colonoscopy is successful in the majority of patients and the polyp detection rate is significantly greater than barium enema. When possible, a repeat attempt at colonoscopy should be considered in patients with a history of a prior incomplete procedure.
Sa1586 Evaluation of Healing Process of Artificial Ulcers in Colorectum After Endoscopic Submucosal Dissection Yukako Nemoto, Koichiro Sato, Sayo Ito, Iruru Maetani Division of Gastroenterology, Daprtment of Medicine, Toho University Ohashi Medical Center, Tokyo, Japan Background and Aim: Endoscopic submucosal dissection (ESD) is recently developed as a method of endoscopic resection, characterized by circumferential mucosal incision and submucosal dissection of the lesion. Since ESD enables en bloc resection of large lesions in any part of the gastrointestinal tract, it has been applied to many larger lesions resulting in the creation of larger artificial ulcers. In a previous endoscopic study, that gastric ulcers artificially created by ESD may heal within 8 weeks, regardless of size and location was reported. The present study was designed to evaluate the quality of post-ESD ulcer healing by endoscopy. Materials and Methods: We evaluated the 24 post-ESD colorectal ulcers using endoscopy post 4 weeks, in 24 patients, sixteen men and eight women, a mean age of 69.8 year, who underwent ESD between January 2008 and October 2010. Endoscopic observation parameters included ulcer location, and healing stage. The locations of ulcers were 4 of cecum, 5 of ascending, 4 of transverse, 1 of descending, 3 of sigmoid, and 7 of rectum. There were eleven cases of carcinoma in adenoma and thirteen cases of adenoma. The eight postESD ulcers that have not healed within 4 weeks were examined again after 8 weeks. Results: All post-ESD ulcers healed within 8 weeks. In ulcers healed within 4 weeks (early healing group), the mean size of specimens was 36.1 mm (long-axis). In ulcers required more than 4 weeks to heal (late healing group), the mean size of specimens was 48.1 mm. A mean size of the resected specimen was significantly different between early healing group and late healing group. The locations of ulcers were not significantly different in two groups. Conclusions: Colorectal ulcers artificially created by ESD heal within 8 weeks, regardless of size and location. The larger size of specimen will take longer time to heal.
Sa1587 Is the Prevalence of Colorectal Adenoma Higher in Patients With Gastric Neoplasm? Chang Hwan Choi, Sang Pyo Han, Bong Ki Cha, Beom Jin Kim, Hyoung-Chul Oh, Jeong Wook Kim, Jae Hyuk Do, Jae G. Kim, Se Kyung Chang Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea Background & Aims: Colorectal cancer is more frequently detected among primary gastric cancer patients. We aimed to compare the prevalence of colorectal adenomas between patients with gastric neoplasm and healthy controls. Methods: This study was retrospectively performed in Chung-Ang University Hospital from January 2005 through June 2010. A total of 172 patients with gastric neoplasm who underwent colonoscopy were enrolled. Age and sex matched 860 subjects without gastric neoplasm who underwent colonoscopy in health promotion center were enrolled as the controls. Various factors were evaluated such as gender, age, body mass index (BMI), abdominal circumference, and the frequency of multiple (ⱖ2 sites), large (ⱖ1cm) and
Volume 73, No. 4S : 2011
GASTROINTESTINAL ENDOSCOPY
AB215