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Sa1749 Can Gastric Transit Time From Video Capsule Endoscopy Be Used to Diagnose Gastroparesis? Within-Patient Precision and Comparison to Gastric Emptying Scintigraphy
Abstracts
EUS layer involved
Mucosa (N)
Sa1748 Prediction of Malignant Risk of Gastrointestinal Stromal Tumor by Endoscopic Ultrasonography MI Na Kim*2, Sang Gyun Kim1, Jong Pil Im1, Joo Sung Kim1, Hyun Chae Jung1 1 Gastroenterology, Seoul National University Hospital, Seoul, Republic of Korea; 2Center for Health Promotion, Seoul National University Hospital, Seoul, Republic of Korea
Submucosa p-value (N)* (Fisher’s-exact)
Type of adenoma Tubular adenoma 2 2 Tubulovillous adenoma 12 4 Presence of high grade dysplasia No 10 4 Yes 4 2 Focality of high grade dysplasia Focal 3 1 Multifocal 1 1 Submucosal lift No 0 1 Yes 12 2 En bloc resection No 8 3 Yes 4 0 Post-EMR bleeding No 11 2 Yes 1 1 Pathological (deep) margin positive No 4 3 Yes 5 1 Recurrence at first endoscopic follow-up No 10 1 Yes 0 3 Final endoscopic follow-up Recurrence 1 2 Eradication 9 2
0.549
1.00
Background: Although the incidence of gastrointestinal stromal tumors (GISTs) has been increasing, preoperative accurate prediction of the malignant risk of GISTs is difficult. The aim of this study was whether endoscopic ultrasonography (EUS) could predict the malignant risk of GISTs less than 5cm in size preoperatively. Methods: The patients with gastric GIST in 2 - 5cm in size who underwent surgical resection were enrolled and retrospectively reviewed. The patients were grouped by tumor size at 1cm interval, and EUS features were compared for the malignant risk in terms of heterogeneity, echogenecity, calcification, cystic change, lobulation, and umbilication. Malignant risk was estimated based on mitotic count and tumor size, and the correlation of EUS features with malignant risk was evaluated. Results: A total of 75 patients were enrolled, and preoperative EUS was performed in 55 patients. The mean size of tumors was 3.43⫾0.92cm. With regard to malignant risk, 51(68%) tumors had very low risk, and 24 (32%) tumors had moderate risk. The proportion of tumors according to malignant risk was not different among the groups. EUS characteristics between very low risk group and moderate risk group were evaluated. There was no significant difference between very low risk and moderate risk group in terms of malignant features of EUS. Conclusions: Tumor size and EUS features could not predict preoperatively malignant risk of gastric GISTs less than 5cm in size, and the patients more than two-thirds had very low risk. Preoperative diagnostic modality to predict malignant risk of GIST is necessary to prevent overtreatment. Keywords: Gastrointestinal stromal tumor, malignant risk, endoscopic ultrasonography
1.00
0.200
0.516
0.371
0.829
0.011
0.176
Total (N)
Total (N)
p-value
95% CI
14 13
6 5
0.817 0.582
⫺20.116, 16.06 ⫺20.116, 16.06
14
6
0.487
⫺34.89, 17.26
Endoscopic size Post-resection tissue size Polyp percentage luminal circumference
Sa1749 Can Gastric Transit Time From Video Capsule Endoscopy Be Used to Diagnose Gastroparesis? Within-Patient Precision and Comparison to Gastric Emptying Scintigraphy Amir Zarrinpar*1,2, Divya Chandrasekar2, Denise Kalmaz1,2 1 Gastroenterology, UCSD, La Jolla, CA; 2School of Medicine, UCSD, La Jolla, CA
*One patient had involvement of muscularis propria and thus underwent surgery. Pathology revealed adenoma to be mucosal. This patient was included in analysis since submucosal was involved.
Figure 1. Type of adenoma, pathology, pre-resection EUS, type of resection and follow-up data of 31 adenomas diagnosed between 2003-2011at a tertiary center.
www.giejournal.org
Background: Gastroparesis can be diagnosed with gastric emptying scintigraphy (GES); wireless motility capsules that measures pH, pressure and temperature; or 13C breath tests. The role that video capsule endoscopy (VCE) can play in the diagnosis of gastroparesis remains unknown. Furthermore, it is unclear whether VCE can precisely measure gastric transit time. Aims: To assess the precision of gastric transit time within patients who have had repeated orally ingested VCEs and to compare the gastric transit time from VCE to gastric emptying time from GES by assessing their correlation. Methods: All capsule studies performed between June 2004 and October 2011 from our institution were reviewed. Of the 386 studies, six patients had at least two VCEs where the capsule was ingested orally. In addition, 17 patients had a VCE where the capsule was ingested orally and a GES that was performed within the study time period. Results: Gastric transit time in patients who had two VCEs were highly correlated (Pearson’s r ⫽ 0.94, p ⬍ 0.005). However, gastric transit times were not correlated to the t1/2 of GES. There was no correlation when we compared the results of all 17 patients who had both studies done (Pearson’s r ⫽ ⫺0.32, n.s.). Since inpatient hospitalization during VCE or an endoscopy within 24 hours of capsule placement may slow gastric transit time, we excluded three patients who met this criteria from our analysis. However, the remaining 14 patients did not have a correlation between gastric transit time and t1/2 of GES (Pearson’s r ⫽ ⫺0.36, n.s.). Finally, patients’ medications prior to both procedures were reviewed. Nine patients who had an addition or discontinuation of a pro-motility drug (e.g. metoclopramide) or an anti-motility drug (e.g. narcotics) were excluded. The remaining five patients still did not have a correlation between gastric transit time and t1/2 of GES (Pearson’s r ⫽ 0.21, n.s.). Conclusions: VCE is a highly precise test of gastric transit time, which is an important criterion if it is to play a role in the diagnosis of gastroparesis. However, in this small retrospective study, we could not find a correlation between gastric transit time as assessed by VCE and t1/2 of GES, despite trying to control for confounding factors such as inpatient status, recent endoscopy, or changes in motility altering medication. Since gastric transit time from VCE is a measure of motility of indigestible material, an elevated value is not predictive of gastroparesis as diagnosed with GES which measures the emptying of digestible material.
Volume 75, No. 4S : 2012
GASTROINTESTINAL ENDOSCOPY
AB263
EUS layer involved
Mucosa (N)
Sa1748 Prediction of Malignant Risk of Gastrointestinal Stromal Tumor by Endoscopic Ultrasonography MI Na Kim*2, Sang Gyun Kim1, Jong Pil Im1, Joo Sung Kim1, Hyun Chae Jung1 1 Gastroenterology, Seoul National University Hospital, Seoul, Republic of Korea; 2Center for Health Promotion, Seoul National University Hospital, Seoul, Republic of Korea
Submucosa p-value (N)* (Fisher’s-exact)
Type of adenoma Tubular adenoma 2 2 Tubulovillous adenoma 12 4 Presence of high grade dysplasia No 10 4 Yes 4 2 Focality of high grade dysplasia Focal 3 1 Multifocal 1 1 Submucosal lift No 0 1 Yes 12 2 En bloc resection No 8 3 Yes 4 0 Post-EMR bleeding No 11 2 Yes 1 1 Pathological (deep) margin positive No 4 3 Yes 5 1 Recurrence at first endoscopic follow-up No 10 1 Yes 0 3 Final endoscopic follow-up Recurrence 1 2 Eradication 9 2
0.549
1.00
Background: Although the incidence of gastrointestinal stromal tumors (GISTs) has been increasing, preoperative accurate prediction of the malignant risk of GISTs is difficult. The aim of this study was whether endoscopic ultrasonography (EUS) could predict the malignant risk of GISTs less than 5cm in size preoperatively. Methods: The patients with gastric GIST in 2 - 5cm in size who underwent surgical resection were enrolled and retrospectively reviewed. The patients were grouped by tumor size at 1cm interval, and EUS features were compared for the malignant risk in terms of heterogeneity, echogenecity, calcification, cystic change, lobulation, and umbilication. Malignant risk was estimated based on mitotic count and tumor size, and the correlation of EUS features with malignant risk was evaluated. Results: A total of 75 patients were enrolled, and preoperative EUS was performed in 55 patients. The mean size of tumors was 3.43⫾0.92cm. With regard to malignant risk, 51(68%) tumors had very low risk, and 24 (32%) tumors had moderate risk. The proportion of tumors according to malignant risk was not different among the groups. EUS characteristics between very low risk group and moderate risk group were evaluated. There was no significant difference between very low risk and moderate risk group in terms of malignant features of EUS. Conclusions: Tumor size and EUS features could not predict preoperatively malignant risk of gastric GISTs less than 5cm in size, and the patients more than two-thirds had very low risk. Preoperative diagnostic modality to predict malignant risk of GIST is necessary to prevent overtreatment. Keywords: Gastrointestinal stromal tumor, malignant risk, endoscopic ultrasonography
1.00
0.200
0.516
0.371
0.829
0.011
0.176
Total (N)
Total (N)
p-value
95% CI
14 13
6 5
0.817 0.582
⫺20.116, 16.06 ⫺20.116, 16.06
14
6
0.487
⫺34.89, 17.26
Endoscopic size Post-resection tissue size Polyp percentage luminal circumference
Sa1749 Can Gastric Transit Time From Video Capsule Endoscopy Be Used to Diagnose Gastroparesis? Within-Patient Precision and Comparison to Gastric Emptying Scintigraphy Amir Zarrinpar*1,2, Divya Chandrasekar2, Denise Kalmaz1,2 1 Gastroenterology, UCSD, La Jolla, CA; 2School of Medicine, UCSD, La Jolla, CA
*One patient had involvement of muscularis propria and thus underwent surgery. Pathology revealed adenoma to be mucosal. This patient was included in analysis since submucosal was involved.
Figure 1. Type of adenoma, pathology, pre-resection EUS, type of resection and follow-up data of 31 adenomas diagnosed between 2003-2011at a tertiary center.
www.giejournal.org
Background: Gastroparesis can be diagnosed with gastric emptying scintigraphy (GES); wireless motility capsules that measures pH, pressure and temperature; or 13C breath tests. The role that video capsule endoscopy (VCE) can play in the diagnosis of gastroparesis remains unknown. Furthermore, it is unclear whether VCE can precisely measure gastric transit time. Aims: To assess the precision of gastric transit time within patients who have had repeated orally ingested VCEs and to compare the gastric transit time from VCE to gastric emptying time from GES by assessing their correlation. Methods: All capsule studies performed between June 2004 and October 2011 from our institution were reviewed. Of the 386 studies, six patients had at least two VCEs where the capsule was ingested orally. In addition, 17 patients had a VCE where the capsule was ingested orally and a GES that was performed within the study time period. Results: Gastric transit time in patients who had two VCEs were highly correlated (Pearson’s r ⫽ 0.94, p ⬍ 0.005). However, gastric transit times were not correlated to the t1/2 of GES. There was no correlation when we compared the results of all 17 patients who had both studies done (Pearson’s r ⫽ ⫺0.32, n.s.). Since inpatient hospitalization during VCE or an endoscopy within 24 hours of capsule placement may slow gastric transit time, we excluded three patients who met this criteria from our analysis. However, the remaining 14 patients did not have a correlation between gastric transit time and t1/2 of GES (Pearson’s r ⫽ ⫺0.36, n.s.). Finally, patients’ medications prior to both procedures were reviewed. Nine patients who had an addition or discontinuation of a pro-motility drug (e.g. metoclopramide) or an anti-motility drug (e.g. narcotics) were excluded. The remaining five patients still did not have a correlation between gastric transit time and t1/2 of GES (Pearson’s r ⫽ 0.21, n.s.). Conclusions: VCE is a highly precise test of gastric transit time, which is an important criterion if it is to play a role in the diagnosis of gastroparesis. However, in this small retrospective study, we could not find a correlation between gastric transit time as assessed by VCE and t1/2 of GES, despite trying to control for confounding factors such as inpatient status, recent endoscopy, or changes in motility altering medication. Since gastric transit time from VCE is a measure of motility of indigestible material, an elevated value is not predictive of gastroparesis as diagnosed with GES which measures the emptying of digestible material.
Volume 75, No. 4S : 2012
GASTROINTESTINAL ENDOSCOPY
AB263