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Su1515 Heads or Tails: "Proximal" and "Distal" Terminology for Pancreatico-Biliary Anatomy: a Multi-Center Study
Abstracts
Su1514 The Clinical Experiences of Novel Tag-Less Agile Patency Capsule for 100 Cases With Suspected Small Bowel Stenosis Masanao Nakamura*1, Yoshiki Hirooka2, Takeshi Yamamura1, Koji Yamada1, Asuka Nagura2, Toru Yoshimura1, Arihiro Nakano1, Hiroshi Oshima1, Kazuhiro Furukawa1, Kohei Funasaka2, Eizaburo Ohno2, Ryoji Miyahara1, Hiroki Kawashima1, Akihiro Itoh1, Osamu Watanabe1, Takafumi Ando1, Naoki Ohmiya3, Hidemi Goto1,2 1 Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan; 2Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan; 3Department of Gastroenterology, Fujita Health University, Toyoake, Japan Introduction: Capsule endoscopy (CE) is promising tool for diagnosing small bowel diseases with non-invasive manner. However, if the patient is suspected having small bowel stenosis, the CE procedure has a risk of retention. The patency capsule (PC), which is same size as CE and dissolvable, is useful for confirming the patency prior to diagnostic CE. PC consists of lactose, 10% Barium and Radio Frequency Identification (RFID) tag which is identified by the specific metal scanner. Nevertheless, impaction of RFID tag to the stricture could cause small bowel ileus. The novel RFID tag-less Agile PC was introduced into clinical practice in 2012. This PC is the same type as second generation PC except that RFID tag is removed. The aim of this study was to evaluate the usefulness of the new PC and analyze the independent factor to affect the patency of PC retrospectively. Patients and Methods: Of 154 patients who were scheduled to undergo CE at Nagoya University Hospital between July 2012 and September 2013, 100 consecutive patients who underwent PC were enrolled. The indications of PC were 40 Crohn’s diseases, 18 abdominal symptoms, 17 tumors, 16 chronic intestinal diseases, 3 NSAIDs users, 3 ileus and 3 others. The PC procedure had two patterns according to the timing of PC swallowing in the morning or just before going to bed. The confirmation of patency was defined as the case whose PC was passed out of the body within 33 hours or showed in the colon at X-ray or CT scan after 33 hours of PC swallowing. Once the patency of PC was confirmed, CE was scheduled within one week. The primary end point was to examine the retention rate of the CE in the patients after the confirmation of patency. The secondary end point was to evaluate the factors related to the confirmation of patency. Results: Of 100 patients who swallowed PC, 53 (53%) had the intact body excretion of PC within 33 hours. Of the other 47 patients whose PCs were not out of body, 34 had PC in the colon on abdominal X-ray or CT scan. So, these 34 patients could also undergo CE. In total, patency was confirmed in 87 (87%) patients. Of 87 patients who underwent CE, 83 (95%) had whole small bowel observation within CE examination time. There was no retention in all the patients. Abnormal findings were obtained in 60 patients and 41 of them introduced new therapy or changed treatment. Of 40 patients with Crohn’s disease, 17 (42%) changed the treatment. Univariate analysis for the factors related to the confirmation of patency showed that abdominal symptom, stenosis on imaging, lower ADL and injection time affected significantly. At the result of multivariate analysis of these 4 factors, stenosis on imaging was the most influential factor (PZ0.002, odds ratio 16.387). Conclusion: The novel PC was useful for evaluating the patency of the small bowel to confirm the safer CE procedure.
Su1515 Heads or Tails: "Proximal" and "Distal" Terminology for Pancreatico-Biliary Anatomy: a Multi-Center Study Harshit S. Khara*1, Amitpal S. Johal1, David L. Diehl1, Shivangi Kothari2, Vivek Kaul2, Seth a. Gross3, Christopher J. Dimaio4, William B. Hale5, Rami Abbass6, Marvin Ryou7, Brian G. Turner8, Amrita Sethi9, Truptesh H. Kothari10 1 Department of Gastroenterology & Nutrition, Geisinger Medical Center, Danville, PA; 2Division of Gastroenterology & Hepatology, University of Rochester Medical Center, Rochester, NY; 3NYU Langone Medical Center, New York, NY; 4Mount Sinai School of Medicine, New York, NY; 5 Norwalk Hospital, Norwalk, CT; 6Case Western Reserve University School of Medicine, Cleveland, OH; 7Brigham and Women’s Hospital, Boston, MA; 8Weill Cornell Medical College, New York, NY; 9Columbia University Medical Center, New York, NY; 10Fox Chase Cancer Center, Philadelphia, PA Introduction: The use of the terms "proximal" and "distal" in an anatomical context is well established in the medical literature. However, when used as part of endoscopic, surgical or radiologic reporting for describing pancreatic anatomy, the terms "proximal" and "distal" can create confusion and potential for serious implications, if misinterpreted. Aim: The aim of this survey is to investigate the practice patterns related to the use of the terms "proximal" and "distal" in labeling the pancreaticobiliary ductal system anatomy. We used an online survey tool to assess the extent of variability in the use of these terms amongst gastroenterologists, surgeons and radiologists. Methods: We created a simple pancreatico-biliary anatomy based online survey (figure 1) and asked gastroenterologists, surgeons and radiologists to label various parts of the common bile duct (CBD) and pancreatic duct (PD) using the terms "proximal", "distal", "not sure", or "other" with the option of free text description. An online link to the survey was emailed to various physicians with the
AB198 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 5S : 2014
collaborative efforts of a multi-center, multi-specialty participation. Results: Two hundred seventy completed surveys were received and analyzed online, comprising of 133 gastroenterologists, 60 radiologists, 57 surgeons, and 20 other physicians from radiation oncology, medical oncology, and surgical pathology. Overall, there was a majority consensus describing the superior part of the CBD as "proximal CBD" (78%) and the peri-ampullary part as "distal CBD" (83%). However, there was marked variability when referring to the pancreatic duct: being labeled in the head of the pancreas as "proximal PD" (46%) versus "distal PD" (36%); and in the tail of the pancreas as "distal PD" (47%) versus "proximal PD" (35%). Overall, 18% of all physicians (but 38% of radiologists) used descriptive terms for labeling both sites of the PD instead of the above terms. Conclusions: The terms "proximal" and "distal" are frequently used by various specialties for describing pancreatico-biliary anatomy, but there seems to be a major discordance about its meaning not only amongst different specialties but also among different physicians in the same specialty. This variability is mostly related to the description of the PD anatomy (table1), but it is also seen to some extent for the CBD. This can lead to misinterpretation and potential medical errors. The use of consensual descriptive terms such as "PD in the head" or "downstream PD" and "PD in the tail" or "upstream PD", rather than "proximal" or "distal", may be a safer, more accurate and meaningful alternative, with an aim to improve quality of medical reporting and avoid potential medical errors related to misinterpretation. Table 1. Responses in reference to the pancreatic duct location by various specialties Anatomical location:
PD in pancreatic head
Label used:
\"Proximal\" \"Distal\" \"Proximal\" \"Distal\"
Gastroenterology (n Z 133) Radiology (n Z 60)* Surgery (n Z 57)
47% 27% 63%
37% 37% 33%
PD in pancreatic tail
34% 37% 32%
50% 25% 63%
*Over one-third of radiologists did not use the above terms, but instead used descriptive terminology to label the pancreatic duct.
Figure 1
Su1516 Endoscopic Flushing With Pronase Improves the Quality of a Gastric Biopsy - a Prospective Study Sun-Young Lee*1, Hye Seung Han2, Jae Myung Cha3, Yu Kyung Cho4, Gwang HA. Kim5, IL-Kwan Chung6 1 Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea; 2Pathology, Konkuk University School of Medicine, Seoul, Republic of Korea; 3Internal Medicine, University of Kyunghee College of Medicine, Seoul, Republic of Korea; 4Internal Medicine, The Catholic University College of Medicine, Seoul, Republic of Korea; 5 Medicine, Pusan National University School of Medicine, Busan, Republic of Korea; 6Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea Background: Pronase, a proteolytic enzyme, is known to improve mucosal visibility during EGD, but little is known about its effects on a gastric biopsy. This study assessed whether endoscopic flushing with pronase improves the quality of a gastric biopsy. Methods: Consecutive subjects who visited for EGD were randomly assigned to either the control group or pronase group in a prospective setting. The first biopsy of the discolored lesion was performed during endoscopy. Endoscopic flushing
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Su1514 The Clinical Experiences of Novel Tag-Less Agile Patency Capsule for 100 Cases With Suspected Small Bowel Stenosis Masanao Nakamura*1, Yoshiki Hirooka2, Takeshi Yamamura1, Koji Yamada1, Asuka Nagura2, Toru Yoshimura1, Arihiro Nakano1, Hiroshi Oshima1, Kazuhiro Furukawa1, Kohei Funasaka2, Eizaburo Ohno2, Ryoji Miyahara1, Hiroki Kawashima1, Akihiro Itoh1, Osamu Watanabe1, Takafumi Ando1, Naoki Ohmiya3, Hidemi Goto1,2 1 Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan; 2Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan; 3Department of Gastroenterology, Fujita Health University, Toyoake, Japan Introduction: Capsule endoscopy (CE) is promising tool for diagnosing small bowel diseases with non-invasive manner. However, if the patient is suspected having small bowel stenosis, the CE procedure has a risk of retention. The patency capsule (PC), which is same size as CE and dissolvable, is useful for confirming the patency prior to diagnostic CE. PC consists of lactose, 10% Barium and Radio Frequency Identification (RFID) tag which is identified by the specific metal scanner. Nevertheless, impaction of RFID tag to the stricture could cause small bowel ileus. The novel RFID tag-less Agile PC was introduced into clinical practice in 2012. This PC is the same type as second generation PC except that RFID tag is removed. The aim of this study was to evaluate the usefulness of the new PC and analyze the independent factor to affect the patency of PC retrospectively. Patients and Methods: Of 154 patients who were scheduled to undergo CE at Nagoya University Hospital between July 2012 and September 2013, 100 consecutive patients who underwent PC were enrolled. The indications of PC were 40 Crohn’s diseases, 18 abdominal symptoms, 17 tumors, 16 chronic intestinal diseases, 3 NSAIDs users, 3 ileus and 3 others. The PC procedure had two patterns according to the timing of PC swallowing in the morning or just before going to bed. The confirmation of patency was defined as the case whose PC was passed out of the body within 33 hours or showed in the colon at X-ray or CT scan after 33 hours of PC swallowing. Once the patency of PC was confirmed, CE was scheduled within one week. The primary end point was to examine the retention rate of the CE in the patients after the confirmation of patency. The secondary end point was to evaluate the factors related to the confirmation of patency. Results: Of 100 patients who swallowed PC, 53 (53%) had the intact body excretion of PC within 33 hours. Of the other 47 patients whose PCs were not out of body, 34 had PC in the colon on abdominal X-ray or CT scan. So, these 34 patients could also undergo CE. In total, patency was confirmed in 87 (87%) patients. Of 87 patients who underwent CE, 83 (95%) had whole small bowel observation within CE examination time. There was no retention in all the patients. Abnormal findings were obtained in 60 patients and 41 of them introduced new therapy or changed treatment. Of 40 patients with Crohn’s disease, 17 (42%) changed the treatment. Univariate analysis for the factors related to the confirmation of patency showed that abdominal symptom, stenosis on imaging, lower ADL and injection time affected significantly. At the result of multivariate analysis of these 4 factors, stenosis on imaging was the most influential factor (PZ0.002, odds ratio 16.387). Conclusion: The novel PC was useful for evaluating the patency of the small bowel to confirm the safer CE procedure.
Su1515 Heads or Tails: "Proximal" and "Distal" Terminology for Pancreatico-Biliary Anatomy: a Multi-Center Study Harshit S. Khara*1, Amitpal S. Johal1, David L. Diehl1, Shivangi Kothari2, Vivek Kaul2, Seth a. Gross3, Christopher J. Dimaio4, William B. Hale5, Rami Abbass6, Marvin Ryou7, Brian G. Turner8, Amrita Sethi9, Truptesh H. Kothari10 1 Department of Gastroenterology & Nutrition, Geisinger Medical Center, Danville, PA; 2Division of Gastroenterology & Hepatology, University of Rochester Medical Center, Rochester, NY; 3NYU Langone Medical Center, New York, NY; 4Mount Sinai School of Medicine, New York, NY; 5 Norwalk Hospital, Norwalk, CT; 6Case Western Reserve University School of Medicine, Cleveland, OH; 7Brigham and Women’s Hospital, Boston, MA; 8Weill Cornell Medical College, New York, NY; 9Columbia University Medical Center, New York, NY; 10Fox Chase Cancer Center, Philadelphia, PA Introduction: The use of the terms "proximal" and "distal" in an anatomical context is well established in the medical literature. However, when used as part of endoscopic, surgical or radiologic reporting for describing pancreatic anatomy, the terms "proximal" and "distal" can create confusion and potential for serious implications, if misinterpreted. Aim: The aim of this survey is to investigate the practice patterns related to the use of the terms "proximal" and "distal" in labeling the pancreaticobiliary ductal system anatomy. We used an online survey tool to assess the extent of variability in the use of these terms amongst gastroenterologists, surgeons and radiologists. Methods: We created a simple pancreatico-biliary anatomy based online survey (figure 1) and asked gastroenterologists, surgeons and radiologists to label various parts of the common bile duct (CBD) and pancreatic duct (PD) using the terms "proximal", "distal", "not sure", or "other" with the option of free text description. An online link to the survey was emailed to various physicians with the
AB198 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 5S : 2014
collaborative efforts of a multi-center, multi-specialty participation. Results: Two hundred seventy completed surveys were received and analyzed online, comprising of 133 gastroenterologists, 60 radiologists, 57 surgeons, and 20 other physicians from radiation oncology, medical oncology, and surgical pathology. Overall, there was a majority consensus describing the superior part of the CBD as "proximal CBD" (78%) and the peri-ampullary part as "distal CBD" (83%). However, there was marked variability when referring to the pancreatic duct: being labeled in the head of the pancreas as "proximal PD" (46%) versus "distal PD" (36%); and in the tail of the pancreas as "distal PD" (47%) versus "proximal PD" (35%). Overall, 18% of all physicians (but 38% of radiologists) used descriptive terms for labeling both sites of the PD instead of the above terms. Conclusions: The terms "proximal" and "distal" are frequently used by various specialties for describing pancreatico-biliary anatomy, but there seems to be a major discordance about its meaning not only amongst different specialties but also among different physicians in the same specialty. This variability is mostly related to the description of the PD anatomy (table1), but it is also seen to some extent for the CBD. This can lead to misinterpretation and potential medical errors. The use of consensual descriptive terms such as "PD in the head" or "downstream PD" and "PD in the tail" or "upstream PD", rather than "proximal" or "distal", may be a safer, more accurate and meaningful alternative, with an aim to improve quality of medical reporting and avoid potential medical errors related to misinterpretation. Table 1. Responses in reference to the pancreatic duct location by various specialties Anatomical location:
PD in pancreatic head
Label used:
\"Proximal\" \"Distal\" \"Proximal\" \"Distal\"
Gastroenterology (n Z 133) Radiology (n Z 60)* Surgery (n Z 57)
47% 27% 63%
37% 37% 33%
PD in pancreatic tail
34% 37% 32%
50% 25% 63%
*Over one-third of radiologists did not use the above terms, but instead used descriptive terminology to label the pancreatic duct.
Figure 1
Su1516 Endoscopic Flushing With Pronase Improves the Quality of a Gastric Biopsy - a Prospective Study Sun-Young Lee*1, Hye Seung Han2, Jae Myung Cha3, Yu Kyung Cho4, Gwang HA. Kim5, IL-Kwan Chung6 1 Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea; 2Pathology, Konkuk University School of Medicine, Seoul, Republic of Korea; 3Internal Medicine, University of Kyunghee College of Medicine, Seoul, Republic of Korea; 4Internal Medicine, The Catholic University College of Medicine, Seoul, Republic of Korea; 5 Medicine, Pusan National University School of Medicine, Busan, Republic of Korea; 6Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea Background: Pronase, a proteolytic enzyme, is known to improve mucosal visibility during EGD, but little is known about its effects on a gastric biopsy. This study assessed whether endoscopic flushing with pronase improves the quality of a gastric biopsy. Methods: Consecutive subjects who visited for EGD were randomly assigned to either the control group or pronase group in a prospective setting. The first biopsy of the discolored lesion was performed during endoscopy. Endoscopic flushing
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