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T1068 The “Buddy” Study: Are There Benefits to Having Bariatric Surgery With a “Buddy?”
weight loss for patients with household members undergoing bariatric surgery. However, people losing larger amount of weight are likely to do better if they have a buddy. Future studies need to control for co-morbidities and use qualitative methodology to increase understanding about the role of buddies. T1069 Appropriateness for Ordinary Hospital Admission of Patients With Nonvariceal Upper Gastrointestinal Haemorrhage Marco Soncini, Fausto Chilovi, Pietro Leo, Omero Triossi, Carlo Buniolo Introduction: Nonvariceal Upper Gastrointestinal Haemorrhage (NVUGH) is a frequent cause of ordinary hospital admission in Gastroenterology Units. Randomized controlled trials, have shown that risk stratification can identify a significant number of low risk patients who can be treated as outpatients (20-30%). Aim of the present study is to determine the percentage of low risk patients inappropriately admitted to hospital, in Italian Gastroenterology Units participating to the RING study. Materials e methods: we analyzed hospital discharge files collected between April and October 2009, from 10 Gastroenterology Units, which issued 211 hospital discharge files of ordinary hospital admission using the Rockall Score (RS) and Glasgow-Blatchford Bleeding Score (GBS) in NVUGH patients. Results: A whole of 211 patients (59% males) with a main diagnosis of NVUGH were identified. The mean age was 69.3±16.1 years. Patients presented a mean comorbidity of 2.9±1.3 and length of hospital stay of 6.9±8.1 days. Endoscopy was done within 9±12 hours. Therapeutic procedures were completed for 49.0% of patients during endoscopy. Mortality was 1.9% (at day 30 mortality 3%) and rebleeding 5.9%. 74.5% of the patients required at least one blood transfusion (mean 2.5±2.3). Patients with high RS (six or more) were 36.9% ; those with low risk (0-2) were 11,3%. GBS = 0 was present in 1.1% No low risk patient with both scorings, either died or rebleeded. The 2 patients with GBS = 0, had an RS of 3. In one, endoscopy revealed an active bleeding (oozing), whilst in the other a nonbleeding visible vessel. Conclusion: Our study, demostrates that low risk patients admitted in Gastroenterology Units partecipating to the RING study group, are now a small group, compared to 1993 Rockall study (30%) and with we shown in 2005 when low risk patients for Rockall score were 16.9%. RS and GBS, as demonstrated in our study, are safe. In our opinion, the presence of an endoscopic triage provides a greater accuracy and a quicker hospital discharge. We are now trying to develop a third predictive model based on Artificial Neural Network rather than on endoscopy. This model is on the whole more complex but can by-pass endoscopy triage.
T1067 Clinical Impact of a Wireless Motility Capsule - A Retrospective Review Allen Lee, Whitney Michalek, Stephen M. Wiener, Braden Kuo Background: The SmartPill capsule is a wireless motility capsule (WMC) that measures transit and pressure profiles continuously in the GI tract (stomach, small bowel and colon). WMC provides information on both transit and motility parameters that may impact diagnosis and management. Aims: 1. To determine if WMC detected new motility abnormalities relative to prior tests and whether this resulted in a new diagnosis. 2. To investigate if WMC agreed/ disagreed with other diagnostic motility tests. 3. To examine if WMC impacted clinical management by leading to changes in diagnosis, medication, diet, further tests, reduction in testing, or surgery. Methods: A retrospective study was performed on 50 patients who presented to a single tertiary center for evaluation of potential GI dysmotilities. All patients underwent WMC as part of their evaluation. A chart review of each patient was conducted including their symptoms, medical and surgical history, medications, diagnostic tests and motility studies to assess the impact of the WMC. Results: A new motility abnormality was found in 68% of pts by WMC, which resulted in a new diagnosis in 44% of pts. The most common new diagnosis was gastroparesis occurring in 16% of pts. The most common indication for ordering WMC was evaluation of gastroparesis occurring in 34% of pts. Of these patients, 76% had delayed gastric emptying time (GET) while only 35% had delayed gastric emptying scintigraphy at 4h (GES). There was positive agreement in 66% of results between WMC and another motility measurement modality. 4h-GES/GET had the most frequent positive agreement in 79% pts. 25 procedures were avoided because of results from WMC including ADM in 26% of the patients and Sitzmarks in 18% of the subjects. Management was changed in 60% patients who underwent WMC examination. The most common change was medication alteration in 48 instances. Dietary changes were recommended in 10% while 10% had recommendations for G/J-tube placement or surgery. 7 subjects were referred to other specialists for consultations based on WMC results. Conclusions: Patients with motility disorders may have a non-specific constellation of symptoms. WMC is a non-invasive, ambulatory modality that can provide information regarding transit times and motility parameters throughout the entire GI tract. These findings suggest that data from the WMC can make an impact on clinical decision making and management.
T1070 Mortality in Chronic Home Parenteral Nutrition Patients With Short Bowel is Associated With Bowel Anatomy John Siepler, Reid A. Nishikawa, Leslie Yu, Thomas G. Diamantidis, Rod J. Okamoto Introduction: Home Parenteral Nutrition(HPN) can be lifesaving for patients with intestinal failure(IF). Despite this, 10 year mortality rates in HPN patients is reported to range from 10-40%. We wanted to determine if mortality rates in patients with IF and short bowel(SBS) on HPN were correlate with mortality rate. Methods: All patients from one home care provider who had been on HPN for >1year and were not expected to wean off HPN for > 1 year qualified. Data collected included patient demographics, duration of HPN, number who had died, and presence or absence of ileocecal valve(ICV) and colon. Mortality was calculated by the number of deaths in each anatomic group divided by the total. Statistics were performed by t test, Chi squared, and logistic regression, with P<0.05 being considered significant. Results: There were 171 patients who qualified. Mean duration of HPN was 16.9±8.4 years for a total of 2,752 patient-years. The mean age was 41±19.6 years, and 106(62%) were female. An ICV was absent in 118 patients(69%) and the colon was absent in 73 patients(42.6%). Age and gender in those two groups were nearly identical to the whole population(p=ns). Overall mortality was 29/171(17%). A comparison of mortality in those with and without a colon or ICV can be seen in Table 1. Risk of mortality for those patients without an ICV was 4.8(95%CI:1.4-16.7,p=0.013), and for those patients without a colon was 2.6(95%CI:1.2-5.9,p=0.022). Discussion: We calculated overall mortality in a large group of patients with IF and SBS on long-term HPN. Overall mortality was 17%, but the mortality was significantly higher in those patients without an ICV or colon. These data are similar to those of Messing(Gastroent,1999;117:1043). It is possible that those patients who underwent operations removing their ICV or colon from intestinal continuity had a more acute course, and thus a higher mortality. More work is needed to associate and find associations and causes of mortality in IF patients on HPN with intestinal anatomy.
T1068 The “Buddy” Study: Are There Benefits to Having Bariatric Surgery With a “Buddy?” Nekee Pandya, Melanie Jay, Iryna Lobach, Elizabeth H. Weinshel, Christine Ren-Fielding BACKGROUND: Support groups lead to better bariatric surgery outcomes, but it is uncertain whether bariatric patients who undergo surgery with other household members achieve similar benefits. Our aim was to explore whether having two or more bariatric patients living together impacts weight loss outcomes. We compared weight change for patients with and without other operated household members at 6 and 12 months. METHODS: We performed a retrospective study using data from the New York University Medical Center Weight Loss Program Research Registry and Bariatric Outcomes Longitudinal Database which consisted of 3574 patients who had undergone bariatric surgery. We classified patients as having “buddies” if they lived at the same address as one or more other patients in the registry. We extracted age, gender, race, initial body mass index, and weight loss at 6 and 12 months. The comparison between the “buddies” and “non-buddies” was performed by examining robust measures of center (median and Wilcoxon test) and variability/tail behavior (quantiles and Kolmogorov-Smirnov test). RESULTS: We included 3527 patients in our analysis and identified 182 (5.2%) who had one or more buddies. There were a higher proportion of men in the buddy group (35.7% vs. 28.2%, p = .04), fewer African Americans (.02% vs. 9.3%, p = .01) and a higher percentage of Caucasians (86% vs. 78%, p = .01). There was no significant difference between median weight loss between buddies and nonbuddies (30.5 pounds (lbs) vs 29 lbs, p = .14 at 6 months, 45 lbs vs 43 lbs, p = .12 at 12 months). At 12 months, there was a significant difference between buddies and non-buddies (3rd quartile and IQR: 74.75, 56.7 vs. 67, 56, p=0.049), suggesting that patients losing at or above the third quartile lose larger amounts of weight if they have a buddy. CONCLUSION: Using a large dataset, we did not show any significant differences in the central tendency
T1071 Central Venous Access Devices in Chronic HPN Patients: Correlation of Duration of Catheter With Underlying Disease John Siepler, Marianne Opilla, Reid A. Nishikawa, Thomas G. Diamantidis, Rod J. Okamoto Background: A central venous access device(CVAD) is needed for home parenteral nutrition(HPN). Long-term HPN patients usually have intestinal failure(IF) caused by a motility disorder(MOT) or short bowel syndrome(SBS). They often require a CVAD for many years, and the duration of a single CVAD is variable. We wanted to determine if cause of IF in HPN patients was associated with duration of a single CVAD, and frequency of CVAD
S-481
AGA Abstracts
AGA Abstracts
of acute GIB were admitted from 2004 to 2008. Discharge diagnosis consistent with acute GIB was matched in 77.2% (3057/3960) of cases. Mean age was 58.5y (range 12-103y) and 66.5% were males. Upper GIB (UGIB) accounted for 1911 (66.7%) cases. The top 3 causes were: 1. Peptic ulcer disease (54.1%), 2. Gastroduodenitis (16.3%) and 3. Mallory Weiss Tear (13.4%). Variceal UGIB (VUGIB) accounted for 7.5% of UGIB events. The proportion of UGIB fell from 69.4% in 2004 to 67.0% in 2008 (p=0.038,R2=0.96). Mortality rates for non-VUGIB fell from 2.5% to 2.1% (p=0.356,R2=0.28) while VUGIB mortality rates fell from 14.9% to 9.0% (p=0.356,R2=0.28). Endoscopic hemostasis rates rose from 97.6% to 99.0% (p=0.093,R2=0.67). Angiotherapy rate was 0.9% with no change over the 5 years. Significant risk factors for mortality among UGIB were: age (odds ratio (OR):1.04; 95% confidence interval (CI):1.02-1.06), number of comorbidities (OR:1.59; 95% CI:1.32-1.90) and ICU admission (OR:17.0; 95% CI:6.5-44.4). Lower GIB (LGIB) accounted for 954 (33.3%) cases. The top 3 causes were: 1. Piles (39.6%), 2. Diverticular disease (29.8%) and 3. Colorectal cancer (14.0%). The proportion of LGIB cases rose from 30.6% in 2004 to 33.0% in 2008 (p=0.032,R2=0.83) and this was contributed by a rise in ischemic colitis cases from 1.2% to 5.9% (p=0.024,R2=0.98). Mortality rate for LGIB was 2.3% with no significant change over the 5 years. Therapeutic colonoscopy rates dropped from 15.2% to 10.3% (p=0.043,R2=0.96) while angiotherapy rates rose from 1.8% to 4.9% (p=0.278,R2= 0.37). Surgical rate was 4.7% without significant change over the 5 years. Significant risk factors for mortality among LGIB were: age (OR:1.07; 95% CI:1.03-1.12), number of comorbidities (OR:1.52, 95% CI:1.14-2.03) and surgery (OR:4.51; 95% CI:1.20-17.0). Conclusions: ED admission diagnosis of acute GIB was correctly matched by in-patient discharge diagnosis in 77.2% of cases. Trend of UGIB was falling with reduction in mortality and surgical rates. There was a rising trend in LGIB, contributed by a rise in ischemic colitis events over the same period. Mortality and surgical rates remained unchanged for LGIB while colonoscopic intervention rates fell and angiotherapy rates rose.
T1067 Clinical Impact of a Wireless Motility Capsule - A Retrospective Review Allen Lee, Whitney Michalek, Stephen M. Wiener, Braden Kuo Background: The SmartPill capsule is a wireless motility capsule (WMC) that measures transit and pressure profiles continuously in the GI tract (stomach, small bowel and colon). WMC provides information on both transit and motility parameters that may impact diagnosis and management. Aims: 1. To determine if WMC detected new motility abnormalities relative to prior tests and whether this resulted in a new diagnosis. 2. To investigate if WMC agreed/ disagreed with other diagnostic motility tests. 3. To examine if WMC impacted clinical management by leading to changes in diagnosis, medication, diet, further tests, reduction in testing, or surgery. Methods: A retrospective study was performed on 50 patients who presented to a single tertiary center for evaluation of potential GI dysmotilities. All patients underwent WMC as part of their evaluation. A chart review of each patient was conducted including their symptoms, medical and surgical history, medications, diagnostic tests and motility studies to assess the impact of the WMC. Results: A new motility abnormality was found in 68% of pts by WMC, which resulted in a new diagnosis in 44% of pts. The most common new diagnosis was gastroparesis occurring in 16% of pts. The most common indication for ordering WMC was evaluation of gastroparesis occurring in 34% of pts. Of these patients, 76% had delayed gastric emptying time (GET) while only 35% had delayed gastric emptying scintigraphy at 4h (GES). There was positive agreement in 66% of results between WMC and another motility measurement modality. 4h-GES/GET had the most frequent positive agreement in 79% pts. 25 procedures were avoided because of results from WMC including ADM in 26% of the patients and Sitzmarks in 18% of the subjects. Management was changed in 60% patients who underwent WMC examination. The most common change was medication alteration in 48 instances. Dietary changes were recommended in 10% while 10% had recommendations for G/J-tube placement or surgery. 7 subjects were referred to other specialists for consultations based on WMC results. Conclusions: Patients with motility disorders may have a non-specific constellation of symptoms. WMC is a non-invasive, ambulatory modality that can provide information regarding transit times and motility parameters throughout the entire GI tract. These findings suggest that data from the WMC can make an impact on clinical decision making and management.
T1070 Mortality in Chronic Home Parenteral Nutrition Patients With Short Bowel is Associated With Bowel Anatomy John Siepler, Reid A. Nishikawa, Leslie Yu, Thomas G. Diamantidis, Rod J. Okamoto Introduction: Home Parenteral Nutrition(HPN) can be lifesaving for patients with intestinal failure(IF). Despite this, 10 year mortality rates in HPN patients is reported to range from 10-40%. We wanted to determine if mortality rates in patients with IF and short bowel(SBS) on HPN were correlate with mortality rate. Methods: All patients from one home care provider who had been on HPN for >1year and were not expected to wean off HPN for > 1 year qualified. Data collected included patient demographics, duration of HPN, number who had died, and presence or absence of ileocecal valve(ICV) and colon. Mortality was calculated by the number of deaths in each anatomic group divided by the total. Statistics were performed by t test, Chi squared, and logistic regression, with P<0.05 being considered significant. Results: There were 171 patients who qualified. Mean duration of HPN was 16.9±8.4 years for a total of 2,752 patient-years. The mean age was 41±19.6 years, and 106(62%) were female. An ICV was absent in 118 patients(69%) and the colon was absent in 73 patients(42.6%). Age and gender in those two groups were nearly identical to the whole population(p=ns). Overall mortality was 29/171(17%). A comparison of mortality in those with and without a colon or ICV can be seen in Table 1. Risk of mortality for those patients without an ICV was 4.8(95%CI:1.4-16.7,p=0.013), and for those patients without a colon was 2.6(95%CI:1.2-5.9,p=0.022). Discussion: We calculated overall mortality in a large group of patients with IF and SBS on long-term HPN. Overall mortality was 17%, but the mortality was significantly higher in those patients without an ICV or colon. These data are similar to those of Messing(Gastroent,1999;117:1043). It is possible that those patients who underwent operations removing their ICV or colon from intestinal continuity had a more acute course, and thus a higher mortality. More work is needed to associate and find associations and causes of mortality in IF patients on HPN with intestinal anatomy.
T1068 The “Buddy” Study: Are There Benefits to Having Bariatric Surgery With a “Buddy?” Nekee Pandya, Melanie Jay, Iryna Lobach, Elizabeth H. Weinshel, Christine Ren-Fielding BACKGROUND: Support groups lead to better bariatric surgery outcomes, but it is uncertain whether bariatric patients who undergo surgery with other household members achieve similar benefits. Our aim was to explore whether having two or more bariatric patients living together impacts weight loss outcomes. We compared weight change for patients with and without other operated household members at 6 and 12 months. METHODS: We performed a retrospective study using data from the New York University Medical Center Weight Loss Program Research Registry and Bariatric Outcomes Longitudinal Database which consisted of 3574 patients who had undergone bariatric surgery. We classified patients as having “buddies” if they lived at the same address as one or more other patients in the registry. We extracted age, gender, race, initial body mass index, and weight loss at 6 and 12 months. The comparison between the “buddies” and “non-buddies” was performed by examining robust measures of center (median and Wilcoxon test) and variability/tail behavior (quantiles and Kolmogorov-Smirnov test). RESULTS: We included 3527 patients in our analysis and identified 182 (5.2%) who had one or more buddies. There were a higher proportion of men in the buddy group (35.7% vs. 28.2%, p = .04), fewer African Americans (.02% vs. 9.3%, p = .01) and a higher percentage of Caucasians (86% vs. 78%, p = .01). There was no significant difference between median weight loss between buddies and nonbuddies (30.5 pounds (lbs) vs 29 lbs, p = .14 at 6 months, 45 lbs vs 43 lbs, p = .12 at 12 months). At 12 months, there was a significant difference between buddies and non-buddies (3rd quartile and IQR: 74.75, 56.7 vs. 67, 56, p=0.049), suggesting that patients losing at or above the third quartile lose larger amounts of weight if they have a buddy. CONCLUSION: Using a large dataset, we did not show any significant differences in the central tendency
T1071 Central Venous Access Devices in Chronic HPN Patients: Correlation of Duration of Catheter With Underlying Disease John Siepler, Marianne Opilla, Reid A. Nishikawa, Thomas G. Diamantidis, Rod J. Okamoto Background: A central venous access device(CVAD) is needed for home parenteral nutrition(HPN). Long-term HPN patients usually have intestinal failure(IF) caused by a motility disorder(MOT) or short bowel syndrome(SBS). They often require a CVAD for many years, and the duration of a single CVAD is variable. We wanted to determine if cause of IF in HPN patients was associated with duration of a single CVAD, and frequency of CVAD
S-481
AGA Abstracts
AGA Abstracts
of acute GIB were admitted from 2004 to 2008. Discharge diagnosis consistent with acute GIB was matched in 77.2% (3057/3960) of cases. Mean age was 58.5y (range 12-103y) and 66.5% were males. Upper GIB (UGIB) accounted for 1911 (66.7%) cases. The top 3 causes were: 1. Peptic ulcer disease (54.1%), 2. Gastroduodenitis (16.3%) and 3. Mallory Weiss Tear (13.4%). Variceal UGIB (VUGIB) accounted for 7.5% of UGIB events. The proportion of UGIB fell from 69.4% in 2004 to 67.0% in 2008 (p=0.038,R2=0.96). Mortality rates for non-VUGIB fell from 2.5% to 2.1% (p=0.356,R2=0.28) while VUGIB mortality rates fell from 14.9% to 9.0% (p=0.356,R2=0.28). Endoscopic hemostasis rates rose from 97.6% to 99.0% (p=0.093,R2=0.67). Angiotherapy rate was 0.9% with no change over the 5 years. Significant risk factors for mortality among UGIB were: age (odds ratio (OR):1.04; 95% confidence interval (CI):1.02-1.06), number of comorbidities (OR:1.59; 95% CI:1.32-1.90) and ICU admission (OR:17.0; 95% CI:6.5-44.4). Lower GIB (LGIB) accounted for 954 (33.3%) cases. The top 3 causes were: 1. Piles (39.6%), 2. Diverticular disease (29.8%) and 3. Colorectal cancer (14.0%). The proportion of LGIB cases rose from 30.6% in 2004 to 33.0% in 2008 (p=0.032,R2=0.83) and this was contributed by a rise in ischemic colitis cases from 1.2% to 5.9% (p=0.024,R2=0.98). Mortality rate for LGIB was 2.3% with no significant change over the 5 years. Therapeutic colonoscopy rates dropped from 15.2% to 10.3% (p=0.043,R2=0.96) while angiotherapy rates rose from 1.8% to 4.9% (p=0.278,R2= 0.37). Surgical rate was 4.7% without significant change over the 5 years. Significant risk factors for mortality among LGIB were: age (OR:1.07; 95% CI:1.03-1.12), number of comorbidities (OR:1.52, 95% CI:1.14-2.03) and surgery (OR:4.51; 95% CI:1.20-17.0). Conclusions: ED admission diagnosis of acute GIB was correctly matched by in-patient discharge diagnosis in 77.2% of cases. Trend of UGIB was falling with reduction in mortality and surgical rates. There was a rising trend in LGIB, contributed by a rise in ischemic colitis events over the same period. Mortality and surgical rates remained unchanged for LGIB while colonoscopic intervention rates fell and angiotherapy rates rose.