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Su1278 Efficacy of Endoluminal Gastroplication in Japanese Patients With Proton Pump Inhibitor-Resistant, Non-Erosive Esophagitis
Abstracts
BPS group
Propofol group
Difficulty of maintenance by 2.57 (2.15) 2.90 (2.32) endoscopist§ Patient cooperation by nurse‡, 8.15 (2.20) 7.84 (2.23) mean (SD), VAS Overall satisfaction with 8.25 (1.82) 7.87 (2.06) sedation by nurse‡ Difficulty of maintenance by 3.25 (2.61) 3.57 (2.69) nurse§ Patient satisfaction with 9.13 (1.16) 8.90 (1.69) sedation‡, mean (SD), VAS Remembered endoscopic 12 (11.8) 18 (17.3) insertion, n (%) Remembered endoscopic 12 (11.8) 13 (12.5) withdrawal, n (%) Felt pain during procedure, n 8 (7.8) 17 (16.3) (%) *Time from sedation start to procedure start. †Time from completion of ERCP or EUS to reaching Aldrete score of 10. ‡0 ⫽ poor; 10 ⫽ excellent. §0 ⫽ easy; 10 ⫽ very difficult.
P value .284 .316 .164 .385 .270 .259 .878 .062
Su1278 Efficacy of Endoluminal Gastroplication in Japanese Patients With Proton Pump Inhibitor-Resistant, Non-Erosive Esophagitis Kunio Kasugai*, Kentaro Tokudome, Yasushi Funaki, Yasuhiro Tamura, Shinya Izawa, Akihito Iida, Mari Mizuno, Naotaka Ogasawara, Makoto Sasaki Gastroenterology, Aichi Medical University, Nagakute, Japan Background and Aims: Non-erosive reflux disease (NERD) accounts for more than half of cases of gastro-esophageal reflux disease. Its pathology is complex, and the disease is often not amenable to treatment with proton pump inhibitor (PPI), which are used as front-line drugs. Though surgical therapy has been reported to be effective as an alternative to drug therapy in NERD, the efficacy of endoscopic treatment in PPI-refractory NERD has not yet been studied. The aim of this study was to evaluate efficacy, safety, and long-term outcomes of endoluminal gastroplication (ELGP) in patients with PPI-resistant NERD. Methods: We evaluated GERD symptoms, QOL, esophageal pH, symptom index (SI), symptom sensitivity index (SSI), number of plications and PPI medication before and after ELGP in patients with PPI-resistant NERD. Results: The mean frequency scale for symptoms of the GERD (FSSG) score decreased significantly from 19.1⫾10.5 before ELGP to 10.3⫾7.4 after 3 months and to 9.3⫾9.9 after 12 months. There were no changes in the number of reflux episodes or SI for reflux events, but the number of symptom events and SSI decreased significantly from before ELGP to 3 months after. After 12 months, 3 patients (16.7%) were able to reduce the amount of PPI medication by 50% or more, and 12 patients (66.7%) were able to discontinue PPI medication altogether. One or more plications remained in 80% and 43% after 3 and 12 months, respectively. There were no serious complications. Conclusions: ELGP was safe, resulted in significant improvement in subjective symptoms, and allowed less medication to be used over the long term, thus demonstrating that it could become an option for the treatment of PPI-refractory NERD.
Su1279 Pre and Post Endoscopic Retrograde Cholangiopancreatography Anesthesia Time in Patients Receiving Monitored Anesthesia Care Versus General Anesthesia Vernon J. Carriere*1, Jason Conway1, Girish Mishra1, Raymond Roy2, John A. Evans1 1 Gastroenterology, Wake Forest University Medical Center, Winston Salem, NC; 2Anesthesia, Wake Forest University Medical Center, Winston Salem, NC Purpose: Many factors determine whether patients will receive monitored anesthesia care (MAC) versus general anesthesia (GA) for an Endoscopic Retrograde Cholangiopancreatography (ERCP). Minimizing delays both pre and post ERCP will maximize throughput, thus allowing for increased procedure volumes.Aim: To determine the contribution of anesthesia to total length of procedure time. Methods: All patients undergoing an ERCP from 1/1/11 to 3/31/ 11 were included. Patients were stratified by indications, type of anesthesia (GA versus MAC) and American Society of Anesthesiologist (ASA) classification. The following times were collected: room in, endoscope insertion, endoscope removal and room out. The time difference between room in and the endoscope insertion was considered the “pre-procedure time”. The time difference between
the endoscope removal and room out was considered the “post-procedure time”. Results: A total of 90 patients were included in the study with 39 MAC cases and 51 GA cases. The mean age was 54.3 years and 58/90 (64.4%) were female. There was no significant difference between the GA and MAC groups in regards to ASA classification (p⫽0.3) with a majority of patients being class II 34/90 (37.8%) or class III 51/90 (56.7%). No statistical significance was found between the groups with regard to indication (p⫽0.8), sex (p⫽0.62) or age (p⫽0.2). The mean pre procedure time for the GA group was 20.8 minutes and 11.1 minutes for the MAC group (p ⬍0.001). The mean post procedure time was 12.9 minutes for the GA group and 6.3 minutes for the MAC group (p ⬍0.001.) The time of the procedure was 33.8 minutes for the GA group and 23.2 minutes for the MAC group (p ⫽ 0.03). The total time was 67.6 minutes for GA and 40.6 minutes for MAC (p ⬍0.001). There were no major complications reported in any of the procedures. Conclusion: The pre and post procedure time, as well as the total procedure time, was significantly shorter for the MAC anesthesia group. In the GA group, the actual procedure time accounted for only 50% of the total time of the procedure. Procedure length and complexity should precipitate discussion between the gastroenterologist and anesthesiologist regarding MAC versus GA. The merits of MAC anesthesia appear implicit for maximizing efficiency while maintaining patient safety when performing ERCP.
Su1280 A Novel Procedure for Gastrocutaneous Fistula Closure Omer J. Deen*1, Keely R. Parisian1, Campbell Harris2, Donald F. Kirby1,2 1 Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH; 2Gastroenterology, Medical College of Virginia, Richmond, VA Background: PEG tubes have allowed for a safe and efficient way to feed patients who cannot tolerate oral feeding, yet have a functioning gastrointestinal tract. Gastrocutaneous fistulas after PEG removal are an unusual and rare complication in adults and may be in part due to poor tissue healing, delayed gastric emptying or increased gastric acid production. Various approaches have been reported to treat PEG-related gastric fistulashowever, their success rate is variable and patients frequently require repeat procedures or more than one technique in combination, including acid suppression therapy, silver nitrate ablation of the PEG tract lining, argon plasma coagulation, fibrin glue, and/or endoclipping. Upon our review, there have been no published case series reporting the use of endoscopic banding to close persistent gastrocutaneous fistulas after PEG removal. Study Design: Four patients with persistent gastrocutaneous fistulas after PEG removal were taken for EGD with banding of the fistula site. This procedure was chosen due to its relative ease of application, low likelihood of needing repeat procedures, and the ability to seal off the gastric opening immediately upon application. Patient follow-up was by telephone within 3 days of having the procedure and then again 1-2 weeks afterwards, to ensure that there was no persistent leakage through the fistula tract. Results: Of the four patients who had persistent gastrocutaneous fistulas after PEG removal, endoscopic banding resulted in complete closure of the fistula in 3 of our 4 patients. In one case, banding was unsuccessful secondary to scarring from prior radiation treatment as well as having a previous PEG tube placed 1 inch from the current fistula site. In this case, a second PEG tube was placed through the original PEG stoma, leading to cessation of the gastric leak. The first case resulted in no recurrence after 3 years. The second and third cases have shown no recurrence after 3 months. The fourth case resulted in a second PEG tube to manage persistent drainage through the tract after unsuccessful banding of the site due to complex endoscopic and anatomical issues. Conclusion: Endoscopic closure of a gastrocutaneous fistula, regardless of technique used, can help avoid surgical intervention. Anatomical changes from any previous treatment modalities may decrease the success rate of fistula banding. However, in most patients, endoscopic banding is a safe and relatively simple alternative in closing persistent gastrocutaneous fistulas due to prior PEG tubes.
Su1281 ERCP Quality Assessment and Outcomes in a Tertiary Referral Center Vivian E. Ekkelenkamp*1, Arjun D. Koch1, Jelle Haringsma2, Robert A. De Man1, Ernst J. Kuipers1 1 Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, Netherlands; 2Department of Gastroenterology and Hepatology, Maasstad Ziekenhuis, Rotterdam, Netherlands Introduction: The ASGE Committee on Outcomes Research recommended monitoring 9 ERCP-specific quality indicators for optimal quality assurance in ERCP. There are however little data available on these indicators and measures for quality are sparse. With the development of a self-assessment tool for ERCP (Rotterdam Assessment Form for ERCP - RAF-E), important key parameters (i.e. appropriateness of indication, assessment of procedural difficulty, cannulation rate, and success rates of sphincterotomy, common bile duct stone extraction
AB277 GASTROINTESTINAL ENDOSCOPY Volume 75, No. 4S : 2012
www.giejournal.org
BPS group
Propofol group
Difficulty of maintenance by 2.57 (2.15) 2.90 (2.32) endoscopist§ Patient cooperation by nurse‡, 8.15 (2.20) 7.84 (2.23) mean (SD), VAS Overall satisfaction with 8.25 (1.82) 7.87 (2.06) sedation by nurse‡ Difficulty of maintenance by 3.25 (2.61) 3.57 (2.69) nurse§ Patient satisfaction with 9.13 (1.16) 8.90 (1.69) sedation‡, mean (SD), VAS Remembered endoscopic 12 (11.8) 18 (17.3) insertion, n (%) Remembered endoscopic 12 (11.8) 13 (12.5) withdrawal, n (%) Felt pain during procedure, n 8 (7.8) 17 (16.3) (%) *Time from sedation start to procedure start. †Time from completion of ERCP or EUS to reaching Aldrete score of 10. ‡0 ⫽ poor; 10 ⫽ excellent. §0 ⫽ easy; 10 ⫽ very difficult.
P value .284 .316 .164 .385 .270 .259 .878 .062
Su1278 Efficacy of Endoluminal Gastroplication in Japanese Patients With Proton Pump Inhibitor-Resistant, Non-Erosive Esophagitis Kunio Kasugai*, Kentaro Tokudome, Yasushi Funaki, Yasuhiro Tamura, Shinya Izawa, Akihito Iida, Mari Mizuno, Naotaka Ogasawara, Makoto Sasaki Gastroenterology, Aichi Medical University, Nagakute, Japan Background and Aims: Non-erosive reflux disease (NERD) accounts for more than half of cases of gastro-esophageal reflux disease. Its pathology is complex, and the disease is often not amenable to treatment with proton pump inhibitor (PPI), which are used as front-line drugs. Though surgical therapy has been reported to be effective as an alternative to drug therapy in NERD, the efficacy of endoscopic treatment in PPI-refractory NERD has not yet been studied. The aim of this study was to evaluate efficacy, safety, and long-term outcomes of endoluminal gastroplication (ELGP) in patients with PPI-resistant NERD. Methods: We evaluated GERD symptoms, QOL, esophageal pH, symptom index (SI), symptom sensitivity index (SSI), number of plications and PPI medication before and after ELGP in patients with PPI-resistant NERD. Results: The mean frequency scale for symptoms of the GERD (FSSG) score decreased significantly from 19.1⫾10.5 before ELGP to 10.3⫾7.4 after 3 months and to 9.3⫾9.9 after 12 months. There were no changes in the number of reflux episodes or SI for reflux events, but the number of symptom events and SSI decreased significantly from before ELGP to 3 months after. After 12 months, 3 patients (16.7%) were able to reduce the amount of PPI medication by 50% or more, and 12 patients (66.7%) were able to discontinue PPI medication altogether. One or more plications remained in 80% and 43% after 3 and 12 months, respectively. There were no serious complications. Conclusions: ELGP was safe, resulted in significant improvement in subjective symptoms, and allowed less medication to be used over the long term, thus demonstrating that it could become an option for the treatment of PPI-refractory NERD.
Su1279 Pre and Post Endoscopic Retrograde Cholangiopancreatography Anesthesia Time in Patients Receiving Monitored Anesthesia Care Versus General Anesthesia Vernon J. Carriere*1, Jason Conway1, Girish Mishra1, Raymond Roy2, John A. Evans1 1 Gastroenterology, Wake Forest University Medical Center, Winston Salem, NC; 2Anesthesia, Wake Forest University Medical Center, Winston Salem, NC Purpose: Many factors determine whether patients will receive monitored anesthesia care (MAC) versus general anesthesia (GA) for an Endoscopic Retrograde Cholangiopancreatography (ERCP). Minimizing delays both pre and post ERCP will maximize throughput, thus allowing for increased procedure volumes.Aim: To determine the contribution of anesthesia to total length of procedure time. Methods: All patients undergoing an ERCP from 1/1/11 to 3/31/ 11 were included. Patients were stratified by indications, type of anesthesia (GA versus MAC) and American Society of Anesthesiologist (ASA) classification. The following times were collected: room in, endoscope insertion, endoscope removal and room out. The time difference between room in and the endoscope insertion was considered the “pre-procedure time”. The time difference between
the endoscope removal and room out was considered the “post-procedure time”. Results: A total of 90 patients were included in the study with 39 MAC cases and 51 GA cases. The mean age was 54.3 years and 58/90 (64.4%) were female. There was no significant difference between the GA and MAC groups in regards to ASA classification (p⫽0.3) with a majority of patients being class II 34/90 (37.8%) or class III 51/90 (56.7%). No statistical significance was found between the groups with regard to indication (p⫽0.8), sex (p⫽0.62) or age (p⫽0.2). The mean pre procedure time for the GA group was 20.8 minutes and 11.1 minutes for the MAC group (p ⬍0.001). The mean post procedure time was 12.9 minutes for the GA group and 6.3 minutes for the MAC group (p ⬍0.001.) The time of the procedure was 33.8 minutes for the GA group and 23.2 minutes for the MAC group (p ⫽ 0.03). The total time was 67.6 minutes for GA and 40.6 minutes for MAC (p ⬍0.001). There were no major complications reported in any of the procedures. Conclusion: The pre and post procedure time, as well as the total procedure time, was significantly shorter for the MAC anesthesia group. In the GA group, the actual procedure time accounted for only 50% of the total time of the procedure. Procedure length and complexity should precipitate discussion between the gastroenterologist and anesthesiologist regarding MAC versus GA. The merits of MAC anesthesia appear implicit for maximizing efficiency while maintaining patient safety when performing ERCP.
Su1280 A Novel Procedure for Gastrocutaneous Fistula Closure Omer J. Deen*1, Keely R. Parisian1, Campbell Harris2, Donald F. Kirby1,2 1 Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH; 2Gastroenterology, Medical College of Virginia, Richmond, VA Background: PEG tubes have allowed for a safe and efficient way to feed patients who cannot tolerate oral feeding, yet have a functioning gastrointestinal tract. Gastrocutaneous fistulas after PEG removal are an unusual and rare complication in adults and may be in part due to poor tissue healing, delayed gastric emptying or increased gastric acid production. Various approaches have been reported to treat PEG-related gastric fistulashowever, their success rate is variable and patients frequently require repeat procedures or more than one technique in combination, including acid suppression therapy, silver nitrate ablation of the PEG tract lining, argon plasma coagulation, fibrin glue, and/or endoclipping. Upon our review, there have been no published case series reporting the use of endoscopic banding to close persistent gastrocutaneous fistulas after PEG removal. Study Design: Four patients with persistent gastrocutaneous fistulas after PEG removal were taken for EGD with banding of the fistula site. This procedure was chosen due to its relative ease of application, low likelihood of needing repeat procedures, and the ability to seal off the gastric opening immediately upon application. Patient follow-up was by telephone within 3 days of having the procedure and then again 1-2 weeks afterwards, to ensure that there was no persistent leakage through the fistula tract. Results: Of the four patients who had persistent gastrocutaneous fistulas after PEG removal, endoscopic banding resulted in complete closure of the fistula in 3 of our 4 patients. In one case, banding was unsuccessful secondary to scarring from prior radiation treatment as well as having a previous PEG tube placed 1 inch from the current fistula site. In this case, a second PEG tube was placed through the original PEG stoma, leading to cessation of the gastric leak. The first case resulted in no recurrence after 3 years. The second and third cases have shown no recurrence after 3 months. The fourth case resulted in a second PEG tube to manage persistent drainage through the tract after unsuccessful banding of the site due to complex endoscopic and anatomical issues. Conclusion: Endoscopic closure of a gastrocutaneous fistula, regardless of technique used, can help avoid surgical intervention. Anatomical changes from any previous treatment modalities may decrease the success rate of fistula banding. However, in most patients, endoscopic banding is a safe and relatively simple alternative in closing persistent gastrocutaneous fistulas due to prior PEG tubes.
Su1281 ERCP Quality Assessment and Outcomes in a Tertiary Referral Center Vivian E. Ekkelenkamp*1, Arjun D. Koch1, Jelle Haringsma2, Robert A. De Man1, Ernst J. Kuipers1 1 Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, Netherlands; 2Department of Gastroenterology and Hepatology, Maasstad Ziekenhuis, Rotterdam, Netherlands Introduction: The ASGE Committee on Outcomes Research recommended monitoring 9 ERCP-specific quality indicators for optimal quality assurance in ERCP. There are however little data available on these indicators and measures for quality are sparse. With the development of a self-assessment tool for ERCP (Rotterdam Assessment Form for ERCP - RAF-E), important key parameters (i.e. appropriateness of indication, assessment of procedural difficulty, cannulation rate, and success rates of sphincterotomy, common bile duct stone extraction
AB277 GASTROINTESTINAL ENDOSCOPY Volume 75, No. 4S : 2012
www.giejournal.org