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Sa1739 Endoscopic Features of Sporadic Duodenal Polyps, Can We Predict Adenomas?
Abstracts
after double balloon endoscopy (DBE). Repeated DBE may be necessary. However, few studies addressed the performance of repeated DBE. We aimed to evaluate the usefulness of repeated DBE in OGIB. Methods: We retrospectively identified all OGIB patients who underwent DBE in the Cedars-Sinai Medical Center between 11/2004 and 10/2011. From this group of patients, we further abstracted data on repeated DBE for recurrent bleeding through the same direction as in previous examinations. Results: Twenty nine OGIB patients underwent one repeated DBE through the same direction and 3 patients underwent two repeated DBEs. Therefore, a total of 35 repeated DBEs were analyzed. Fifteen of the 32 patients were males. The age of presentation for the first DBE was 72 years (range, 36-85 years). Before the first DBE, 7 had a previous history of intestinal resection for the management of OGIB. Indication of the first DBE was overt OGIB in 24 and occult OGIB in 8. Oral approach only was performed in 21, anal approach only in 3, and both approach in 8. The first DBE identified a probable bleeding source in 21 (66%) of 32 patients: 16 angiodysplasia (all with multiple lesions), 2 Dieulafoy lesions, 1 carcinoid, 1 benign polyp, and 1 hyperemic patch of unknown etiology. Endoscopic interventions, consisted mainly of argon plasma coagulation and clipping, were performed for all lesions except for the carcinoid that was treated by surgical small bowel resection. Thirty two repeated DBEs were performed after a median of 30 weeks (range 1-204 weeks). Indication of the repeated DBE was overt OGIB in 22 and occult OGIB in 10. Oral approach only was performed in 28 and anal approach only in 4. Probable bleeding sources were detected in 17 (53%) of 32 patients. Sixteen (94%) cases were angiodysplasia, of which 14 patients had angiodysplasia also at the first DBE. All 17 patients with detected bleeding sources were managed with endoscopic intervention that consisted mainly of argon plasma coagulation. Seventeen of 21 patients with positive first DBE showed probable bleeding source at the repeated DBE while none of 11 patients with negative first DBE finding did (81% vs. 0%, p⬍0.001). Other factors such as age, gender, indication, previous history of intestinal surgery, antiplatelet agent, anticoagulation, and route of DBE insertion were not related to the detection of bleeding sources at the repeated DBE. Three patients underwent second repeated DBE. Angiodysplasias were detected in 2 patients (67%). Conclusions: Repeated DBE through the same direction may detect bleeding sources in 53% of patients with recurrent OGIB, with virtually all cases related to angiodysplasia. The value of repeating a DBE in the same direction for patients with a prior negative DBE for OGIB is questionable.
Sa1739 Endoscopic Features of Sporadic Duodenal Polyps, Can We Predict Adenomas? Pablo Luna*, Gastón Babot Eraña, Lisandro Pereyra, Raquel González, José M. Mella, Guillermo Nicolás Panigadi, Carolina Fischer, Adriana Mohaidle, Adrián R. Hadad, Silvia C. Pedreira, Daniel G. Cimmino, Luis A. Boerr Gastroenterology and Endoscopy Unit, Hospital Alemán, Buenos Aires, Argentina Background: Sporadic duodenal polyps (SDP) are uncommon lesions and mostly discovered incidentally. Endoscopic identification of duodenal adenomas it’s important due to their possible malignant transformation. Aim: To determine the prevalence and clinical characteristics of SDP in a community hospital in Argentina, and to identify independent predictors for adenomas. Methods: Endoscopic reports from patients undergoing upper gastrointestinal endoscopy (UGIE) from January 2003 to October 2011 were obtained from the electronic database of a private community hospital of Argentina. All patients with duodenal polyps and histological examination were retrospectively included for analysis. From the endoscopy report and clinical records the following data were collected: demographic information, clinical manifestation, endoscopic features of the polyps, other endoscopic finding (gastric polyps, neoplasia and helicobacter pylori status) and histology. Endoscopic approach, number of endoscopy to diagnose and follow-up were also analyzed. Prevalence of SDP and adenomas was calculated. Univariate analysis was performed, to identify characteristics associated with adenomas. Results were expressed in percentages and odds ratio (OR) with its corresponding 95% confidence intervals (CI). A p value ⬍ 0.05 was considered statically significant. Results: Of 7086 UGIE performed in this period, 137 patients had a total of 150 polyps. The prevalence of SDP was 2%. Patients were mostly males (56%), average age was 61.8 years old (27-90). Polyp’s morphology was: sessile (77%), flat lesions (17%) and pedunculated (6%). Average size and polyp number was 4.5mm and 1.76, respectively. 65% were localized in bulb. Most frequent endoscopic approach was initial polypectomy (55%). The most common purpose of UGIE was epigastric pain (35%), and heartburn (12%). Polyp final diagnose was: nonspecific histological findings (34%), Brunner’s gland hyperplasia (31%), adenomas (17%), hyperplasic polyp (11%) and Gastric metaplasia (5%). Average number of UGIE for diagnosis was 1.16. The prevalence of adenomas was 0.33%; they were more frequently in second portion of duodenum with a mean size of 7mm (2-30mm). Only 36% had endoscopic surveillance and recurrence lesions were not found. Polyps size ⬎ 1cm (p⫽0.001 OR 5,68 CI 1,60 - 20,18), second portion location (p⫽0.000 OR 6,88 IC 2,43 - 20,13) and flat polyp morphology (p⫽0.000 OR 7,95 IC 2,71 - 23,63) were significantly associated with
adenoma. Conclusion: In the present study, the prevalence of SDP and adenomas was low, similar to that reported in the literature. We found a significant association between endoscopic features and adenomas that could optimize the initial endoscopic approach.
Sa1740 Clinical Usefulness of Combination Capsule Endoscopy and CT Enterography in Patients With Obscure Gastrointestinal Bleeding Seong Ran Jeon*, Jin-Oh Kim, Ji Ho Ahn, Hyun Gun Kim, Tae Hee Lee, Won Young Cho, Wan Jung Kim, Bong Min Ko, Joo Young Cho, Joon Seong Lee, Moon Sung Lee Departments of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Republic of Korea Aims: Obscure gastrointestinal bleeding (OGIB) with negative gastroscopy and colonoscopy findings is located mainly in the small intestine. The aim of study is to demonstrate the clinical efficacy of capsule endoscopy (CE) and computed tomography enterography (CTE) to diagnose as OGIB. Methods: From January 2008 to September 2011 in Soonchunhyang University Hospital, 54 patients with firstly diagnosed as OGIB were examined with CE in combination with CTE. The data were analyzed retrospectively and the positive findings were signs of active or recent bleeding, observable sources of hemorrhage visualizing any attributable lesions. Results: Overall 54 patients (median age 57, men 66.7% and women 33.3%) were enrolled. Thirty of 54 patients (55.6%) exhibited positive CE findings compared with 12 patients (22.2%) on CTE alone (p ⬍ 0.01). When used in combination, 64.8% (35/54) of patients scored positive findings. The detection rate with combination of diagnostic imaging was significantly higher than that of CTE alone (p ⬍ 0.01), but was not significant higher than that of CE alone (p ⫽ 0.06). The positive detection rate for CE was superior to CTE particularly for detecting lesions limited to mucosa (15 vascular lesions: 87% vs 13%; 17 superficial mucosal lesions: 88% vs 47%). Conclusion: The combination of CE and CTE is critical in the diagnosis of OGIB, given the fact that there was a significant difference in the detection rate between CE plus CTE and CTE alone. Although there was no significant difference between CE plus CTE and CE alone, combination with CE and CTE increased the positive identification of OGIB, thus expected to improve the clinical diagnosis and therapy.
Sa1741 Angioectasia in the Elderly is the Commonest Cause of Obscure Gastrointestinal Bleeding on Capsule Endoscopy Samuel P. Costello*, Jonathan Martin Gastroenterology, Repatriation General Hospital, Adelaide, SA, Australia Background and Aims: Angioectasia of the small intestine are a common cause of obscure gastrointestinal tract bleeding. We have shown that targeted therapy with balloon enteroscopy and argon plasma coagulation is able to reduce bleeding and transfusion requirements. We aimed to determine the yield and distribution of angioectasia as well as the rates of active bleeding in different age groups using capsule endoscopy in patients with recurrent iron deficiency anemia. Method: We retrospectively analyzed data from 303 consecutive capsule endoscopy studies performed from June 2003 until February 2010 for recurrent iron deficiency anemia. The presence of angioectasia, location (first or second half of the small intestine) and presence of fresh bleeding were recorded along with demographic details. Results: There were 127 (42%) out of 303 patients with angioectasia and 43 (14%) with fresh bleeding associated with angioectasia seen at capsule endoscopy. 34 of 43(79%) had bleeding in the first half, 21 (48.8%) had bleeding in the second half and 12 (27.9%) had bleeding in both halves of the small bowel. The yield of angioectasia for patients ⱖ 80 years was 61% vs. 21% for those less than 60 years (p⬍0.01). Those ⱖ80 years were not more likely to have active bleeding. When present, angioectasia was more common in the first half than the second half of the small bowel (72% vs. 54%; p⬍0.01). There was a trend toward more active bleeding in the patients with angioectasia in the first half of the small intestine (34% vs. 20%; p⫽ 0.15). Conclusion: In the setting of recurrent iron deficiency anemia, the yield for angioectasia at capsule endoscopy is much higher in the elderly (⬎80 years). The most common location for angioectastia and bleeding angioectasia is the proximal small intestine.
Sa1742 Capsule Endoscopy in Octogenarians: Analysis of a Large Prospectively Collected Database Victoria Gomez*, Mihir K. Patel, Mark E. Stark, Frank Lukens Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL Introduction: Capsule endoscopy (CE) is a well accepted and accurate diagnostic
AB260 GASTROINTESTINAL ENDOSCOPY Volume 75, No. 4S : 2012
www.giejournal.org
after double balloon endoscopy (DBE). Repeated DBE may be necessary. However, few studies addressed the performance of repeated DBE. We aimed to evaluate the usefulness of repeated DBE in OGIB. Methods: We retrospectively identified all OGIB patients who underwent DBE in the Cedars-Sinai Medical Center between 11/2004 and 10/2011. From this group of patients, we further abstracted data on repeated DBE for recurrent bleeding through the same direction as in previous examinations. Results: Twenty nine OGIB patients underwent one repeated DBE through the same direction and 3 patients underwent two repeated DBEs. Therefore, a total of 35 repeated DBEs were analyzed. Fifteen of the 32 patients were males. The age of presentation for the first DBE was 72 years (range, 36-85 years). Before the first DBE, 7 had a previous history of intestinal resection for the management of OGIB. Indication of the first DBE was overt OGIB in 24 and occult OGIB in 8. Oral approach only was performed in 21, anal approach only in 3, and both approach in 8. The first DBE identified a probable bleeding source in 21 (66%) of 32 patients: 16 angiodysplasia (all with multiple lesions), 2 Dieulafoy lesions, 1 carcinoid, 1 benign polyp, and 1 hyperemic patch of unknown etiology. Endoscopic interventions, consisted mainly of argon plasma coagulation and clipping, were performed for all lesions except for the carcinoid that was treated by surgical small bowel resection. Thirty two repeated DBEs were performed after a median of 30 weeks (range 1-204 weeks). Indication of the repeated DBE was overt OGIB in 22 and occult OGIB in 10. Oral approach only was performed in 28 and anal approach only in 4. Probable bleeding sources were detected in 17 (53%) of 32 patients. Sixteen (94%) cases were angiodysplasia, of which 14 patients had angiodysplasia also at the first DBE. All 17 patients with detected bleeding sources were managed with endoscopic intervention that consisted mainly of argon plasma coagulation. Seventeen of 21 patients with positive first DBE showed probable bleeding source at the repeated DBE while none of 11 patients with negative first DBE finding did (81% vs. 0%, p⬍0.001). Other factors such as age, gender, indication, previous history of intestinal surgery, antiplatelet agent, anticoagulation, and route of DBE insertion were not related to the detection of bleeding sources at the repeated DBE. Three patients underwent second repeated DBE. Angiodysplasias were detected in 2 patients (67%). Conclusions: Repeated DBE through the same direction may detect bleeding sources in 53% of patients with recurrent OGIB, with virtually all cases related to angiodysplasia. The value of repeating a DBE in the same direction for patients with a prior negative DBE for OGIB is questionable.
Sa1739 Endoscopic Features of Sporadic Duodenal Polyps, Can We Predict Adenomas? Pablo Luna*, Gastón Babot Eraña, Lisandro Pereyra, Raquel González, José M. Mella, Guillermo Nicolás Panigadi, Carolina Fischer, Adriana Mohaidle, Adrián R. Hadad, Silvia C. Pedreira, Daniel G. Cimmino, Luis A. Boerr Gastroenterology and Endoscopy Unit, Hospital Alemán, Buenos Aires, Argentina Background: Sporadic duodenal polyps (SDP) are uncommon lesions and mostly discovered incidentally. Endoscopic identification of duodenal adenomas it’s important due to their possible malignant transformation. Aim: To determine the prevalence and clinical characteristics of SDP in a community hospital in Argentina, and to identify independent predictors for adenomas. Methods: Endoscopic reports from patients undergoing upper gastrointestinal endoscopy (UGIE) from January 2003 to October 2011 were obtained from the electronic database of a private community hospital of Argentina. All patients with duodenal polyps and histological examination were retrospectively included for analysis. From the endoscopy report and clinical records the following data were collected: demographic information, clinical manifestation, endoscopic features of the polyps, other endoscopic finding (gastric polyps, neoplasia and helicobacter pylori status) and histology. Endoscopic approach, number of endoscopy to diagnose and follow-up were also analyzed. Prevalence of SDP and adenomas was calculated. Univariate analysis was performed, to identify characteristics associated with adenomas. Results were expressed in percentages and odds ratio (OR) with its corresponding 95% confidence intervals (CI). A p value ⬍ 0.05 was considered statically significant. Results: Of 7086 UGIE performed in this period, 137 patients had a total of 150 polyps. The prevalence of SDP was 2%. Patients were mostly males (56%), average age was 61.8 years old (27-90). Polyp’s morphology was: sessile (77%), flat lesions (17%) and pedunculated (6%). Average size and polyp number was 4.5mm and 1.76, respectively. 65% were localized in bulb. Most frequent endoscopic approach was initial polypectomy (55%). The most common purpose of UGIE was epigastric pain (35%), and heartburn (12%). Polyp final diagnose was: nonspecific histological findings (34%), Brunner’s gland hyperplasia (31%), adenomas (17%), hyperplasic polyp (11%) and Gastric metaplasia (5%). Average number of UGIE for diagnosis was 1.16. The prevalence of adenomas was 0.33%; they were more frequently in second portion of duodenum with a mean size of 7mm (2-30mm). Only 36% had endoscopic surveillance and recurrence lesions were not found. Polyps size ⬎ 1cm (p⫽0.001 OR 5,68 CI 1,60 - 20,18), second portion location (p⫽0.000 OR 6,88 IC 2,43 - 20,13) and flat polyp morphology (p⫽0.000 OR 7,95 IC 2,71 - 23,63) were significantly associated with
adenoma. Conclusion: In the present study, the prevalence of SDP and adenomas was low, similar to that reported in the literature. We found a significant association between endoscopic features and adenomas that could optimize the initial endoscopic approach.
Sa1740 Clinical Usefulness of Combination Capsule Endoscopy and CT Enterography in Patients With Obscure Gastrointestinal Bleeding Seong Ran Jeon*, Jin-Oh Kim, Ji Ho Ahn, Hyun Gun Kim, Tae Hee Lee, Won Young Cho, Wan Jung Kim, Bong Min Ko, Joo Young Cho, Joon Seong Lee, Moon Sung Lee Departments of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Republic of Korea Aims: Obscure gastrointestinal bleeding (OGIB) with negative gastroscopy and colonoscopy findings is located mainly in the small intestine. The aim of study is to demonstrate the clinical efficacy of capsule endoscopy (CE) and computed tomography enterography (CTE) to diagnose as OGIB. Methods: From January 2008 to September 2011 in Soonchunhyang University Hospital, 54 patients with firstly diagnosed as OGIB were examined with CE in combination with CTE. The data were analyzed retrospectively and the positive findings were signs of active or recent bleeding, observable sources of hemorrhage visualizing any attributable lesions. Results: Overall 54 patients (median age 57, men 66.7% and women 33.3%) were enrolled. Thirty of 54 patients (55.6%) exhibited positive CE findings compared with 12 patients (22.2%) on CTE alone (p ⬍ 0.01). When used in combination, 64.8% (35/54) of patients scored positive findings. The detection rate with combination of diagnostic imaging was significantly higher than that of CTE alone (p ⬍ 0.01), but was not significant higher than that of CE alone (p ⫽ 0.06). The positive detection rate for CE was superior to CTE particularly for detecting lesions limited to mucosa (15 vascular lesions: 87% vs 13%; 17 superficial mucosal lesions: 88% vs 47%). Conclusion: The combination of CE and CTE is critical in the diagnosis of OGIB, given the fact that there was a significant difference in the detection rate between CE plus CTE and CTE alone. Although there was no significant difference between CE plus CTE and CE alone, combination with CE and CTE increased the positive identification of OGIB, thus expected to improve the clinical diagnosis and therapy.
Sa1741 Angioectasia in the Elderly is the Commonest Cause of Obscure Gastrointestinal Bleeding on Capsule Endoscopy Samuel P. Costello*, Jonathan Martin Gastroenterology, Repatriation General Hospital, Adelaide, SA, Australia Background and Aims: Angioectasia of the small intestine are a common cause of obscure gastrointestinal tract bleeding. We have shown that targeted therapy with balloon enteroscopy and argon plasma coagulation is able to reduce bleeding and transfusion requirements. We aimed to determine the yield and distribution of angioectasia as well as the rates of active bleeding in different age groups using capsule endoscopy in patients with recurrent iron deficiency anemia. Method: We retrospectively analyzed data from 303 consecutive capsule endoscopy studies performed from June 2003 until February 2010 for recurrent iron deficiency anemia. The presence of angioectasia, location (first or second half of the small intestine) and presence of fresh bleeding were recorded along with demographic details. Results: There were 127 (42%) out of 303 patients with angioectasia and 43 (14%) with fresh bleeding associated with angioectasia seen at capsule endoscopy. 34 of 43(79%) had bleeding in the first half, 21 (48.8%) had bleeding in the second half and 12 (27.9%) had bleeding in both halves of the small bowel. The yield of angioectasia for patients ⱖ 80 years was 61% vs. 21% for those less than 60 years (p⬍0.01). Those ⱖ80 years were not more likely to have active bleeding. When present, angioectasia was more common in the first half than the second half of the small bowel (72% vs. 54%; p⬍0.01). There was a trend toward more active bleeding in the patients with angioectasia in the first half of the small intestine (34% vs. 20%; p⫽ 0.15). Conclusion: In the setting of recurrent iron deficiency anemia, the yield for angioectasia at capsule endoscopy is much higher in the elderly (⬎80 years). The most common location for angioectastia and bleeding angioectasia is the proximal small intestine.
Sa1742 Capsule Endoscopy in Octogenarians: Analysis of a Large Prospectively Collected Database Victoria Gomez*, Mihir K. Patel, Mark E. Stark, Frank Lukens Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL Introduction: Capsule endoscopy (CE) is a well accepted and accurate diagnostic
AB260 GASTROINTESTINAL ENDOSCOPY Volume 75, No. 4S : 2012
www.giejournal.org