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Su1466 Multiple Pseudocysts Managed With Transpapillary Drainage
Abstracts
Su1463 Endoscopic Therapy With Transpapillary Stenting Is Effective in Patients With Grade B Pancreatic Distal Occlusion Failure After Distal Pancreatectomy or Splenectomy Kavous Pakseresht, Savio Reddymasu, Brian Moloney, Daniel C. Buckles, Melissa M. Oropeza-Vail, Scott Stanley, Tuba Esfandyari, Scott Grisolano, Mojtaba S. Olyaee Kansas university Medical Center, Kansas city, KS Purpose: To study the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary pancreatic duct (PD) stent placement in a series of patients with grade B (International Study Group For Pancreatic Fistula classification) pancreatic distal occlusion failure (DOF) occurring as a complication of distal pancreatectomy (DP) or splenectomy. Methods: Eight (5 female) patients with a mean age of 55 years (range: 22-69) underwent endotherapy for grade B pancreatic DOF between January 1999 and May 2010. Base line demographics, duration between surgery and initial ERCP, pancreatogram findings, and details regarding endotherapy during the ERCP were reviewed. Results: The pancreatic DOF was a complication of DP in 6, DP with splenectomy in 1, and splenectomy alone in 1 patient. The mean amylase and lipase level in the peritoneal fluid at the time of initial ERCP was 15648 u/L and 2897 u/L respectively. The mean duration between surgery and the initial ERCP was 47 days (range: 13-85 days). The PD was cannulated and a transpapillary PD stent was deployed successfully in all patients. Seven patients (87%) had complete resolution of the pancreatic DOF after a mean number of 4 ERCP’s (range: 2-10). The mean duration between the initial PD stent placement and resolution of the pancreatic DOF was 121 days (range: 44-389 days). One patient was lost to follow-up. No serious complications were reported during ERCP. Conclusion: 1) A majority of grade B pancreatic DOF’s occurring as a complication of DP or splenectomy resolve after transpapillary PD stent placement. However, patients might require several endoscopic procedures prior to complete resolution of the pancreatic DOF. 2) ERCP with PD stent placement should be offered to patients with pancreatic DOF as a safe and effective alternative to surgery.
Su1464 Pancreatic Duct Brush Cytology Can Be an Effective and Safe Method in Pancreatic Diseases Fatih Aslan2, Emrah Alper2, BehlüL Baydar1, Zafer Buyraç2, Serdar Akça2, Belkis Unsal2 1 Gastroenterology and Surgery, Memorial Antalya Hospital, Antalya, Turkey; 2Gastroenterology, Ataturk Training and Research Hospital, Izmir, Turkey Benign or malign reasons may cause pancreatic duct abnormalities like stenosis or dilatation. Although imaging studies may show pancreatic duct abnormalities cannot differentiate malign or benign stenosis. Pancreatic cancer can be diagnosed 33-76% in pancreatic fluid cytology and 47-67% in pancreas brush cytology. In this study, the accuracy of pancreatic cytologic samples targeting the reason of disease are investigated in the patients with pancreatic duct abnormality. Between January 2009 and April 2010, brush cytologic pancreatic duct samples were collected with ERCP from patients with pancreatic duct abnormality detected with screening methods (EUS, CT, MRI). Collected samples were examined by two experienced patholog. Patients were followed up at least 24 hours for postprocedure complications. Levels of CA 19-9 were recorded. Cyto-pathologic data were compared with operation or EUS biopsy results. Data were analized with SPSS 17.0.Fifteen patients were male, 5 were female and mean age was 67⫾8 years. 16 patients were diagnosed as pancreas cancer and 4 were chronic pancreatitis with operation or EUS-FNA. The diagnose was true in 15 (75%) patients and 5 (25%) were misdiagnosed. The diagnose was confirmed 12 of the pancreas cancer and 3 of the chronic pancreatitis patients with pancreatic duct brush cytology. 4 patients with pancreas cancer and 1 patient with chronic pancreatitis could not be diagnosed (25%). Sensitivity, specificity, positive and negative productive value and accuracy of pancreatic duct brush cytology were 75%, 75%, 92,3%, 42,9% and 75%, respectively. CA 19-9 level was over normal values in all pancreas cancer patients and in one (25%) chronic pancreatitis patient. Within 24 hours high amylase leves without any clinical outcome was detected 5 of the patients after procedure. Amylase level regressed within normal values in the following days (min 2-Max 5 days). According to our results, diagnostic accuracy of pancreatic duct brush cytology is compatible with benign and malign pancreatic diseases in the literature. Even though an invasive procedure, the pancreatic duct brush cytology with low complication rate and diagnostic accuracy is a safe method.
www.giejournal.org
Su1465 Association Between Smoking and the Change of Computed Tomography Findings in Chronic Pancreatitis Jeong Woo Lee, Ho Gak Kim, Jimin Han, Byung Seok Kim, Jin Tae Jung, Joong Goo Kwon, Eun Young Kim, Chang Hyeong Lee Department of Internal Medicine,Catholic University of Daegu School of Medicine, Daegu, Korea, Daegu, Republic of Korea Background: Smoking and alcohol are two well-known risk factors for chronic pancreatitis. However, there are only few studies about association between smoking and changes of computed tomography (CT) findings such as pancreatic calcification in chronic pancreatitis. Objectives: We evaluated association between cigarette smoking and changes of CT findings in chronic pancreatitis. Methods: In this retrospective study, 59 patients with chronic pancreatitis who underwent initial and follow-up CT scans between January 2002 and September 2010 were included. CT findings of chronic pancreatitis included pancreatic calcification, atrophy of pancreatic parenchyma, and pancreatic duct dilatation. Pancreatic calcification was graded into mild, moderate and severe using a scoring system of distribution, size, and number of calcification. Amount of alcohol intake and cigarette smoking and development of steatorrhea, diabetes mellitus and pancreatic cancer after diagnosis of chronic pancreatitis were also recorded. Results: Mean age of the patients was 54.5⫾14.7 years. There were 53 men (89.8%). Etiology of chronic pancreatitis was as follows: alcohol in 47 (79.7%), idiopathic in 7 (15.3%), familial in 2, congenital anomaly in 2, and gallstone in 1. Duration of follow-up was 56.3⫾ 24.5 months. At the time of diagnosis, CT findings were calcification in 35 (59.3%), duct dilatation in 31 (52.5%), and atrophy in 21 (35.6%) patients. In the follow-up CT, progression of calcification was seen in 37 (62.7%) patients. Progression of calcification was more common in smokers than non-smokers and ex-smokers {30/38(78.9%) vs. 7/21(33.3%) patients, p⫽0.001}. Progression of calcification was more common in drinkers than non-drinkers {17/21(81%) vs. 20/38(52.6%), p⫽0.031}. With increase in amount of cigarette smoking, calcification grade increased according (7 in non-smoker and ex-smoker, 18 in ⬍ 1 pack/day, 20 in ⱖ 1 pack/day, p⫽0.001). There was no association between smoking and atophy and duct dilatation (p⫽0.314 and 0.797, respectively). During the follow-up, de novo diabetes mellitus developed in 19, pancreatic cancer in 1, and steatorrhea in 4 patients. Conclusions: In patients with chronic pancreatitis, continued cigarette smoking accelerated pancreatic calcification and the amount of smoking was associated with progression of calcification.
Su1466 Multiple Pseudocysts Managed With Transpapillary Drainage Jai Bikhchandani1, Bennie R. Upchurch2 1 Surgery, Creighton University Medical Center, Omaha, NE; 2internal medicine, Creighton University Medical Center, Omaha, NE Background: Management of a single pancreatic pseudocyst with endoscopic transpapillary drainage is a well accepted treatment modality. However, there only a few reported cases of primary endoscopic drainage of multiple pseudocysts . Case report: A 44 year old female with long history of alcohol abuse was admitted with chronic abdominal pain, poor oral intake and anorexia. The patient has had multiple admissions in the past 12 months with relapsing pancreatitis complicated by pseudocysts from alcohol abuse. She has had a laparoscopic cholecystectomy in the past. A CT scan at this admission showed worsened ascites along with several pseudocysts adjacent to the body and tail of pancreas. She was not deemed to be a surgical candidate due to multiple cysts at various locations and different stages of maturation. GI team was consulted for an alternative management strategy. ERCP was therefore performed to assess for any communication of the pancreatic duct (PD) with the cyst(s) and to exclude pancreatic duct fistula as a cause of ascites. A pancreatogram showed a markedly dilated pancreatic duct. On delayed images we saw filling of a saccular structure inferior to the pancreatic tail consistent with a visible connection with a pseudocyst. The decision was therefore made to place a 5 FR (French) x 7 cm pancreatic stent. After 2 weeks of pancreatic duct stenting, the patient was admitted with fevers. ERCP was repeated which showed PD dilated in the body of pancreas with abrupt tapering in the head prompting us to do a pancreatic sphincterotomy followed by a balloon dilatation of the narrowed segment. A 5FR x 10 cm single pigtail pancreatic stent was replaced with purulent drainage through the stent seen at the time of the procedure. A repeat CT scan after 3 weeks showed a marked resolution in the pseudocysts with significant improvement in symptoms. Conclusion: Transpapillary drainage for treatment of multiple pancreatic pseudocysts is a safe alternative to surgery. Larger case series are needed to establish a definite role for this procedure.
Volume 73, No. 4S : 2011
GASTROINTESTINAL ENDOSCOPY
AB273
Abstracts
GI tract disease. Recently developed direct peroral cholangioscopy (D-POC) using an ultra-slim endoscope enables inspection of bile duct using white light image (WLI) combined with CVC image under standard endoscopic set-up. The aim of this study was to evaluate the usefulness of D-POC by using CVC image with i-scan for the diagnosis of biliary tract lesions. Method; 18 patients with biliary-tract lesions on D-POC were included this study. After detection abnormal lesion of bile duct on D-POC using an ultra-slim endoscope (EG-1690K, Pentax, Tokyo, Japan), patient underwent CVC using i-scan. We assessed three factors including surface structure, surface vascular architecture, and the margin of the lesion. Forceps biopsy under direct visualization was tried in all patients. The success rate, efficacy, and adverse events were evaluated. Results; Bile duct lesions were malignant biliary strictures in 7, benign biliary strictures in 3, polypoid lesions in 4, superficial elevated lesions in 2, and ductal inflammations in 2. D-POC using i-scan was performed successfully in all patients even bile stained lesions. The image quality was not affected by bile during i-scan observation. Visualization of the surface structure by i-scan observation was better than conventional WLI observation. Identification of the surface vascular architecture of the lesions by i-scan was significantly better than with conventional WLI on D-POC (P⬍0.05). Forceps biopsy through D-POC successfully performed in 14/18 (78.8%) patients. Conclusions; D-POC by using computed virtual chromoendoscopy with i-scan may be helpful for the evaluation of bile duct lesion without the influence of bile. However, comparing other enhanced endoscopy, and randomized, large scale trials are needed.
Su1468 Subsquamous Intestinal Metaplasia Is Common At the Squamocolumnar Junction in Native Barrett’s Esophagus Michael J. Bartel2, Nora R. Ratcliffe3, Scott A. Hirschman4, Amitabh Srivastava3, Stuart R. Gordon2, Richard I. Rothstein2, Heiko Pohl12 1 Gastroenterology, VA Medical Center, White River Junction, VT; 2 Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; 3Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; 4 Pathology, VA Medical Center, Lebanon, NH Background: Barrett intestinal metaplasia (IM) may extent beneath normal squamous epithelium at the squamocolumnar junction (SCJ) and hence escape surveillance biopsies or endoscopic therapy of Barrett dysplasia. The magnitude of subsquamous intestinal metaplasia in native Barrett’s esophagus is unknown. Objective: Examine the rate of subsquamous IM proximal to the SCJ in native Barrett esophagus. Method: We enrolled consecutive patients with biopsy proven Barrett esophagus, who presented for Barrett surveillance endoscopy at two academic medical centers. Four quadrant biopsies were obtained from the squamous epithelium exactly at the SCJ and 5-10mm above the SCJ. The main outcome measure was the rate of patients with any subsquamous IM overall and by distance from the SCJ. We performed regression analysis to examine a possible association between the presence of subsquamous IM and length of the Barrett segment, use of Proton pump inhibitor (PPI) therapy, and duration of reflux symptoms. Results: We examined 222 squamous epithelial biopsies from 36 Barrett patients (97% male, mean age 69.4 years, SD ⫾8.7) with a mean Barrett length of 3.0 cm (SD ⫾2.5cm). 35 (97%) patients had no dysplasia, and one (3%) had mucosal carcinoma. 33 (92%) patients had at least one biopsy proven subsquamous IM. 32 (89%) patients had subsquamous IM in biopsies obtained from the SCJ and 18 (50%) within 5-10mm above the SCJ. Of all 222 biopsies 39% contained subsquamous IM; 56% from SCJ biopsies and 23% from biopsies 5-10mm proximal to the SCJ. None of the biopsies were dysplastic. Length of Barrett esophagus, PPI use, or duration of reflux symptoms did not affect the presence of subsquamous IM 5-10mm above the SCJ. Conclusion: These preliminary results suggest that a surprisingly high proportion of Barrett patients have subsquamous IM within 10mm of the SCJ. Assuming that subsquamous IM is clinically important surveillance protocols and endoscopic therapy may need to consider subsquamous Barrett extension.
Su1467 Direct PerOral Cholangioscopic Diagnosis of Bile Duct Lesions by Computed Virtual Chromoendoscopy Using I-Scan; Preliminary Study Jong Ho Moon1, Hyun Jong Choi1, Jong Chan Lee1, Seul Ki Min1, Bong Min Ko1, Su Jin Hong1, Hyun Cheol Koo1, Tae Hoon Lee1, Young Koog Cheon2, Young Deok Cho2, Sang-Heum Park1 1 Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon, Republic of Korea; 2Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Seoul, Republic of Korea
Su1469 Early Esophageal Cancer: Changing Treatment Trends in an Upper GI (Gastrointestinal) Tertiary Referral Centre Over the Past Decade (2000-2010) Naoimh J. O’Farrell1, Narayanasamy Ravi1, John O. Larkin1, G. F. Wilson3, Cian Muldoon4, John V. Reynolds1, Dermot O’Toole2 1 Department of Surgery, Trinity College Dublin, Trinity Centre for Health Sciences, St James’s Hospital, Dublin 8, Ireland; 2Department of Gastroenterology, Trinity College Dublin, St James’s Hospital, Dublin 8, Ireland; 3Department of Radiology, St James’s Hospital, Dublin 8, Ireland; 4Department of Pathology, St James’s Hospital, Dublin 8, Ireland
Background; Computed virtual chromoendoscopy (CVC) is new image-enhanced endoscopy that enhances surface structure and mucosal vascular architecture in
Background: Barrett’s esophagus surveillance programs have led to increased detection of early malignant lesions (EM) defined as high grade dysplasia (HGD),
AB274 GASTROINTESTINAL ENDOSCOPY Volume 73, No. 4S : 2011
www.giejournal.org
Su1463 Endoscopic Therapy With Transpapillary Stenting Is Effective in Patients With Grade B Pancreatic Distal Occlusion Failure After Distal Pancreatectomy or Splenectomy Kavous Pakseresht, Savio Reddymasu, Brian Moloney, Daniel C. Buckles, Melissa M. Oropeza-Vail, Scott Stanley, Tuba Esfandyari, Scott Grisolano, Mojtaba S. Olyaee Kansas university Medical Center, Kansas city, KS Purpose: To study the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary pancreatic duct (PD) stent placement in a series of patients with grade B (International Study Group For Pancreatic Fistula classification) pancreatic distal occlusion failure (DOF) occurring as a complication of distal pancreatectomy (DP) or splenectomy. Methods: Eight (5 female) patients with a mean age of 55 years (range: 22-69) underwent endotherapy for grade B pancreatic DOF between January 1999 and May 2010. Base line demographics, duration between surgery and initial ERCP, pancreatogram findings, and details regarding endotherapy during the ERCP were reviewed. Results: The pancreatic DOF was a complication of DP in 6, DP with splenectomy in 1, and splenectomy alone in 1 patient. The mean amylase and lipase level in the peritoneal fluid at the time of initial ERCP was 15648 u/L and 2897 u/L respectively. The mean duration between surgery and the initial ERCP was 47 days (range: 13-85 days). The PD was cannulated and a transpapillary PD stent was deployed successfully in all patients. Seven patients (87%) had complete resolution of the pancreatic DOF after a mean number of 4 ERCP’s (range: 2-10). The mean duration between the initial PD stent placement and resolution of the pancreatic DOF was 121 days (range: 44-389 days). One patient was lost to follow-up. No serious complications were reported during ERCP. Conclusion: 1) A majority of grade B pancreatic DOF’s occurring as a complication of DP or splenectomy resolve after transpapillary PD stent placement. However, patients might require several endoscopic procedures prior to complete resolution of the pancreatic DOF. 2) ERCP with PD stent placement should be offered to patients with pancreatic DOF as a safe and effective alternative to surgery.
Su1464 Pancreatic Duct Brush Cytology Can Be an Effective and Safe Method in Pancreatic Diseases Fatih Aslan2, Emrah Alper2, BehlüL Baydar1, Zafer Buyraç2, Serdar Akça2, Belkis Unsal2 1 Gastroenterology and Surgery, Memorial Antalya Hospital, Antalya, Turkey; 2Gastroenterology, Ataturk Training and Research Hospital, Izmir, Turkey Benign or malign reasons may cause pancreatic duct abnormalities like stenosis or dilatation. Although imaging studies may show pancreatic duct abnormalities cannot differentiate malign or benign stenosis. Pancreatic cancer can be diagnosed 33-76% in pancreatic fluid cytology and 47-67% in pancreas brush cytology. In this study, the accuracy of pancreatic cytologic samples targeting the reason of disease are investigated in the patients with pancreatic duct abnormality. Between January 2009 and April 2010, brush cytologic pancreatic duct samples were collected with ERCP from patients with pancreatic duct abnormality detected with screening methods (EUS, CT, MRI). Collected samples were examined by two experienced patholog. Patients were followed up at least 24 hours for postprocedure complications. Levels of CA 19-9 were recorded. Cyto-pathologic data were compared with operation or EUS biopsy results. Data were analized with SPSS 17.0.Fifteen patients were male, 5 were female and mean age was 67⫾8 years. 16 patients were diagnosed as pancreas cancer and 4 were chronic pancreatitis with operation or EUS-FNA. The diagnose was true in 15 (75%) patients and 5 (25%) were misdiagnosed. The diagnose was confirmed 12 of the pancreas cancer and 3 of the chronic pancreatitis patients with pancreatic duct brush cytology. 4 patients with pancreas cancer and 1 patient with chronic pancreatitis could not be diagnosed (25%). Sensitivity, specificity, positive and negative productive value and accuracy of pancreatic duct brush cytology were 75%, 75%, 92,3%, 42,9% and 75%, respectively. CA 19-9 level was over normal values in all pancreas cancer patients and in one (25%) chronic pancreatitis patient. Within 24 hours high amylase leves without any clinical outcome was detected 5 of the patients after procedure. Amylase level regressed within normal values in the following days (min 2-Max 5 days). According to our results, diagnostic accuracy of pancreatic duct brush cytology is compatible with benign and malign pancreatic diseases in the literature. Even though an invasive procedure, the pancreatic duct brush cytology with low complication rate and diagnostic accuracy is a safe method.
www.giejournal.org
Su1465 Association Between Smoking and the Change of Computed Tomography Findings in Chronic Pancreatitis Jeong Woo Lee, Ho Gak Kim, Jimin Han, Byung Seok Kim, Jin Tae Jung, Joong Goo Kwon, Eun Young Kim, Chang Hyeong Lee Department of Internal Medicine,Catholic University of Daegu School of Medicine, Daegu, Korea, Daegu, Republic of Korea Background: Smoking and alcohol are two well-known risk factors for chronic pancreatitis. However, there are only few studies about association between smoking and changes of computed tomography (CT) findings such as pancreatic calcification in chronic pancreatitis. Objectives: We evaluated association between cigarette smoking and changes of CT findings in chronic pancreatitis. Methods: In this retrospective study, 59 patients with chronic pancreatitis who underwent initial and follow-up CT scans between January 2002 and September 2010 were included. CT findings of chronic pancreatitis included pancreatic calcification, atrophy of pancreatic parenchyma, and pancreatic duct dilatation. Pancreatic calcification was graded into mild, moderate and severe using a scoring system of distribution, size, and number of calcification. Amount of alcohol intake and cigarette smoking and development of steatorrhea, diabetes mellitus and pancreatic cancer after diagnosis of chronic pancreatitis were also recorded. Results: Mean age of the patients was 54.5⫾14.7 years. There were 53 men (89.8%). Etiology of chronic pancreatitis was as follows: alcohol in 47 (79.7%), idiopathic in 7 (15.3%), familial in 2, congenital anomaly in 2, and gallstone in 1. Duration of follow-up was 56.3⫾ 24.5 months. At the time of diagnosis, CT findings were calcification in 35 (59.3%), duct dilatation in 31 (52.5%), and atrophy in 21 (35.6%) patients. In the follow-up CT, progression of calcification was seen in 37 (62.7%) patients. Progression of calcification was more common in smokers than non-smokers and ex-smokers {30/38(78.9%) vs. 7/21(33.3%) patients, p⫽0.001}. Progression of calcification was more common in drinkers than non-drinkers {17/21(81%) vs. 20/38(52.6%), p⫽0.031}. With increase in amount of cigarette smoking, calcification grade increased according (7 in non-smoker and ex-smoker, 18 in ⬍ 1 pack/day, 20 in ⱖ 1 pack/day, p⫽0.001). There was no association between smoking and atophy and duct dilatation (p⫽0.314 and 0.797, respectively). During the follow-up, de novo diabetes mellitus developed in 19, pancreatic cancer in 1, and steatorrhea in 4 patients. Conclusions: In patients with chronic pancreatitis, continued cigarette smoking accelerated pancreatic calcification and the amount of smoking was associated with progression of calcification.
Su1466 Multiple Pseudocysts Managed With Transpapillary Drainage Jai Bikhchandani1, Bennie R. Upchurch2 1 Surgery, Creighton University Medical Center, Omaha, NE; 2internal medicine, Creighton University Medical Center, Omaha, NE Background: Management of a single pancreatic pseudocyst with endoscopic transpapillary drainage is a well accepted treatment modality. However, there only a few reported cases of primary endoscopic drainage of multiple pseudocysts . Case report: A 44 year old female with long history of alcohol abuse was admitted with chronic abdominal pain, poor oral intake and anorexia. The patient has had multiple admissions in the past 12 months with relapsing pancreatitis complicated by pseudocysts from alcohol abuse. She has had a laparoscopic cholecystectomy in the past. A CT scan at this admission showed worsened ascites along with several pseudocysts adjacent to the body and tail of pancreas. She was not deemed to be a surgical candidate due to multiple cysts at various locations and different stages of maturation. GI team was consulted for an alternative management strategy. ERCP was therefore performed to assess for any communication of the pancreatic duct (PD) with the cyst(s) and to exclude pancreatic duct fistula as a cause of ascites. A pancreatogram showed a markedly dilated pancreatic duct. On delayed images we saw filling of a saccular structure inferior to the pancreatic tail consistent with a visible connection with a pseudocyst. The decision was therefore made to place a 5 FR (French) x 7 cm pancreatic stent. After 2 weeks of pancreatic duct stenting, the patient was admitted with fevers. ERCP was repeated which showed PD dilated in the body of pancreas with abrupt tapering in the head prompting us to do a pancreatic sphincterotomy followed by a balloon dilatation of the narrowed segment. A 5FR x 10 cm single pigtail pancreatic stent was replaced with purulent drainage through the stent seen at the time of the procedure. A repeat CT scan after 3 weeks showed a marked resolution in the pseudocysts with significant improvement in symptoms. Conclusion: Transpapillary drainage for treatment of multiple pancreatic pseudocysts is a safe alternative to surgery. Larger case series are needed to establish a definite role for this procedure.
Volume 73, No. 4S : 2011
GASTROINTESTINAL ENDOSCOPY
AB273
Abstracts
GI tract disease. Recently developed direct peroral cholangioscopy (D-POC) using an ultra-slim endoscope enables inspection of bile duct using white light image (WLI) combined with CVC image under standard endoscopic set-up. The aim of this study was to evaluate the usefulness of D-POC by using CVC image with i-scan for the diagnosis of biliary tract lesions. Method; 18 patients with biliary-tract lesions on D-POC were included this study. After detection abnormal lesion of bile duct on D-POC using an ultra-slim endoscope (EG-1690K, Pentax, Tokyo, Japan), patient underwent CVC using i-scan. We assessed three factors including surface structure, surface vascular architecture, and the margin of the lesion. Forceps biopsy under direct visualization was tried in all patients. The success rate, efficacy, and adverse events were evaluated. Results; Bile duct lesions were malignant biliary strictures in 7, benign biliary strictures in 3, polypoid lesions in 4, superficial elevated lesions in 2, and ductal inflammations in 2. D-POC using i-scan was performed successfully in all patients even bile stained lesions. The image quality was not affected by bile during i-scan observation. Visualization of the surface structure by i-scan observation was better than conventional WLI observation. Identification of the surface vascular architecture of the lesions by i-scan was significantly better than with conventional WLI on D-POC (P⬍0.05). Forceps biopsy through D-POC successfully performed in 14/18 (78.8%) patients. Conclusions; D-POC by using computed virtual chromoendoscopy with i-scan may be helpful for the evaluation of bile duct lesion without the influence of bile. However, comparing other enhanced endoscopy, and randomized, large scale trials are needed.
Su1468 Subsquamous Intestinal Metaplasia Is Common At the Squamocolumnar Junction in Native Barrett’s Esophagus Michael J. Bartel2, Nora R. Ratcliffe3, Scott A. Hirschman4, Amitabh Srivastava3, Stuart R. Gordon2, Richard I. Rothstein2, Heiko Pohl12 1 Gastroenterology, VA Medical Center, White River Junction, VT; 2 Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; 3Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; 4 Pathology, VA Medical Center, Lebanon, NH Background: Barrett intestinal metaplasia (IM) may extent beneath normal squamous epithelium at the squamocolumnar junction (SCJ) and hence escape surveillance biopsies or endoscopic therapy of Barrett dysplasia. The magnitude of subsquamous intestinal metaplasia in native Barrett’s esophagus is unknown. Objective: Examine the rate of subsquamous IM proximal to the SCJ in native Barrett esophagus. Method: We enrolled consecutive patients with biopsy proven Barrett esophagus, who presented for Barrett surveillance endoscopy at two academic medical centers. Four quadrant biopsies were obtained from the squamous epithelium exactly at the SCJ and 5-10mm above the SCJ. The main outcome measure was the rate of patients with any subsquamous IM overall and by distance from the SCJ. We performed regression analysis to examine a possible association between the presence of subsquamous IM and length of the Barrett segment, use of Proton pump inhibitor (PPI) therapy, and duration of reflux symptoms. Results: We examined 222 squamous epithelial biopsies from 36 Barrett patients (97% male, mean age 69.4 years, SD ⫾8.7) with a mean Barrett length of 3.0 cm (SD ⫾2.5cm). 35 (97%) patients had no dysplasia, and one (3%) had mucosal carcinoma. 33 (92%) patients had at least one biopsy proven subsquamous IM. 32 (89%) patients had subsquamous IM in biopsies obtained from the SCJ and 18 (50%) within 5-10mm above the SCJ. Of all 222 biopsies 39% contained subsquamous IM; 56% from SCJ biopsies and 23% from biopsies 5-10mm proximal to the SCJ. None of the biopsies were dysplastic. Length of Barrett esophagus, PPI use, or duration of reflux symptoms did not affect the presence of subsquamous IM 5-10mm above the SCJ. Conclusion: These preliminary results suggest that a surprisingly high proportion of Barrett patients have subsquamous IM within 10mm of the SCJ. Assuming that subsquamous IM is clinically important surveillance protocols and endoscopic therapy may need to consider subsquamous Barrett extension.
Su1467 Direct PerOral Cholangioscopic Diagnosis of Bile Duct Lesions by Computed Virtual Chromoendoscopy Using I-Scan; Preliminary Study Jong Ho Moon1, Hyun Jong Choi1, Jong Chan Lee1, Seul Ki Min1, Bong Min Ko1, Su Jin Hong1, Hyun Cheol Koo1, Tae Hoon Lee1, Young Koog Cheon2, Young Deok Cho2, Sang-Heum Park1 1 Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon, Republic of Korea; 2Digestive Disease Center, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Seoul, Republic of Korea
Su1469 Early Esophageal Cancer: Changing Treatment Trends in an Upper GI (Gastrointestinal) Tertiary Referral Centre Over the Past Decade (2000-2010) Naoimh J. O’Farrell1, Narayanasamy Ravi1, John O. Larkin1, G. F. Wilson3, Cian Muldoon4, John V. Reynolds1, Dermot O’Toole2 1 Department of Surgery, Trinity College Dublin, Trinity Centre for Health Sciences, St James’s Hospital, Dublin 8, Ireland; 2Department of Gastroenterology, Trinity College Dublin, St James’s Hospital, Dublin 8, Ireland; 3Department of Radiology, St James’s Hospital, Dublin 8, Ireland; 4Department of Pathology, St James’s Hospital, Dublin 8, Ireland
Background; Computed virtual chromoendoscopy (CVC) is new image-enhanced endoscopy that enhances surface structure and mucosal vascular architecture in
Background: Barrett’s esophagus surveillance programs have led to increased detection of early malignant lesions (EM) defined as high grade dysplasia (HGD),
AB274 GASTROINTESTINAL ENDOSCOPY Volume 73, No. 4S : 2011
www.giejournal.org