T1588: The Relationship of Endoscopic Cross Sectional Distribution Between Erosive Esophagitis and Barrett's Esophagus in Japanese Population

Abstracts the stent-in-stent technique.Methods: Consecutive patients, referred to 3 endoscopy units in the period 2007-2009 treated by the stent-in-stent technique, were reviewed. Initially, partially covered metal stents were inserted for benign (15) and malignant conditions (2, removal because of start chemo radiation (1) and recurrent food impaction(1)). Stents were left in situ for a median of 41 days (18-192). When the stent was found to be embedded, a fully covered plastic (Polyflex, Boston Scientific) or a fully covered metal stent (SX-Ella, ELLA-CS), was placed in the first stent. Results: In total, 21 stent-in-stent procedures were performed in 17 patients (9 males). Placement of a fully covered stent (Polyflex n⫽10, SX-Ella n⫽11) was technically successful in all patients. In 19/21 (90%) procedures, both stents were successfully removed in one procedure after a median of 12(5-18) days. In 2 patients, removal of both stents required two endoscopies because of persisting stent embedding (1) and bleeding after stent removal (1). In 8 (47%) patients the initial disorder had resolved after stent removal and no further endoscopic interventions were needed. In 4 (24%) patients, a repeat endoscopic intervention was required during follow-up because of progressive malignant or benign dysphagia. In 5 (29%) patients, following stent removal a new partially covered stent was placed because of a persisting fistula or leak. In 4 of these patients, the stent-in-stent technique was successfully repeated because of recurrent stent embedding. One (5%) procedure was complicated by severe haemorrhage, which was treated with argon plasma coagulation. No other complications occurred. Conclusion: The stent-in-stent technique is safe and effective for removal of partially covered stents that are embedded in the esophageal wall. Nonetheless, there is a need for fully covered esophageal stents with low migration rates that effectively seal perforations and leaks.

capsule is initially activated for 3 minutes before hibernation, enabling the visualization of the esophagus, although the suitability of the esophageal exploration with this capsule has not been analyzed to date.AIM: To compare PillCam-COLON and PillCamESO1 capsules in the assessment of distal esophageal mucosaPATIENTS Y METHODS: Several parameters for the study of esophageal mucosa (esophageal transit time, number of Z-line frames, number of cases in which there were ⬍4 frames of Z-line, number of cases in which it was observed ⬎75% and ⬍25% of Z-line) were prospectively recorded in patients who underwent PillCam Colon capsule endoscopy for colonic disease or screening. These results were compared with a patient with esophageal pathology who underwent an exploration with PillCam ESO. The same ingestion protocol was used in both group (right supine position). Additionally, the standard colonic prep (diet, laxatives and prokinetics) was used in the patients who underwent PillCam-Colon capsule endoscopy.RESULTS: 103 were analyzed, 47 (23F/24M, 50.89 ⫾ 21.27 years) in PillCam ESO1 group and 56 (28F/28M, 45.50 ⫾ 24.47 years) in PillCam Colon group. The values of the variables studied are shown in the table below, and their analysis shows a statistically significant difference in the number of Z-line frames recorded by PillCam ESO1 vs PillCam Colon (7 ⫾ 62.21 vs 1.5 ⫾ 9.95; p ⫽ 0.007). However, there was no difference in the number of cases in which the Z-line was seen in more than 75% of its extension (16/47, 34.04% vs 35/56, 39.29%, P ⫽ 0.58).CONCLUSIONS: PillCamCOLON capsule obtains fewer images of the Z-line during its passage through the esophagus than PillCam-ESO1; however, the percentage of cases in which the Z-line is fully or nearly fully observed is similar with both devices. This finding justifies the design and development of direct comparison studies between PillCam-COLON and conventional upper gastrointestinal endoscopy.

T1588 The Relationship of Endoscopic Cross Sectional Distribution Between Erosive Esophagitis and Barrett’s Esophagus in Japanese Population Seiji Kimura, Masanori Tanaka

n Age (Median ⫾ std desv) Sex Esophageal Transit Time (s) (Median ⫾ std desv) Nbr of Z-line frames (Median ⫾ std desv) Nbr of pts with ⬍4 Z-line frames Nbr of pts with ⬎75% of Z-line seen with the technique Nbr of pts with ⬍25% of Z-line seen with the technique

Background and Aims: The vast majority of Japanese patients with Barrett’s esophagus has a short segment Barrett esophagus (SSBE) less than 3cm from esohago-gastric junction, which is commonly associated with endoscopic esophagitis. The study aimed to compare endoscopic distributions in cross section between mucosal brake and SSBE at the distal esophagus to explain the pathogenetic relationship between erosive esophagitis and Barrett’s esophagus in Japanese. Methods: The present study enrolled 334 patients with endoscopic esophagitis diagnosed by LA classification (mean age 65.1⫹-13.5yr, M:F⫽186: 148) including 74 (22.2%) patients with associated SSBE. The esophageal video clips of these patients were reviewed, and endoscopic distributions of lesions at the esophago-gastric junction in cross section as in a clock-face were recorded. The 12 o’clock to 3 o’clock quadrant indicated the first quadrant (Q1) with the other quadrants (Q2 to Q4) numbered in a clockwise direction. Each prevalence of erosive esophagitis (grade A, B, C or D) and Barrett’s esophagus (SSBE) by quadrants was statistically analyzed. Results: The prevalences of erosive esophagitis occurring in Q1, Q2, Q3, and Q4 were 48.9%, 21.7%, 7.4%, and 22.0% in patients with grade A esophagitis (172 cases with 309 lesions), 37.0%, 24.7%, 11.2%, and 27.1% in those with grade B (121 cases with 295 lesions), 28.3%, 26.9%, 19.4%, and 25.4% in those with grade C or D (41 cases with 134 lesions), respectively. A predominant occurrence of mucosal brake in the first quadrant (Q1) was observed in patients with grade A esophagitis, although the prevalence of the lesions in the first quadrant became almost equal to those in the other quadrants in patients with grade C or D esophagitis. The statistical significance was evident between patients with grade A and B (p⬍0.05), and between those with grade A and grade C or D (p⬍0.0005). In contrast the prevalences of associated SSBE occurring in Q1, Q2, Q3, and Q4 were 27.4%, 16.8%, 13.0%, and 42.8% in patients with endoscopic esophagitis (74 cases with 208 lesions). The lesions of SSBE occurred predominantly in the forth quadrant (Q4), and the distribution of associated SSBE was significantly different from those of mucosal brake in any grades (p⬍0.01). Conclusion: The distribution of associated SSBE in cross section at esophago-gastric junction differed significantly from the distributions of erosions in patients with endoscopic esophagitis, especially in those with mild esophagitis. Different ethiology of Barrett’s esophagus and erosive esophagitis should be taken into consideration particulary in short segment Barrett esophagus in Japanese.

T1589 PillCam Colon vs PillCam ESO1 for the Assessment of Distal Esophageal Mucosa Vanesa Mendez-Rufian, Patricia Cordero-Ruiz, Cristina Castro-Marquez, Angel Caunedo-Alvarez, Francisco Pellicer-Bautista, Juan Manuel Herrerias-Gutierrez BACKGROUND: PillCam-ESO1 capsule (14 frames/s) has demonstrated adequate sensitivity and specificity for the assessment of esophageal pathology. PillCam Colon (4 frames/s) has shown its usefulness in the study of colonic disease. This

AB316 GASTROINTESTINAL ENDOSCOPY

Volume 71, No. 5 : 2010

PillCam ESO1

PillCam COLON

P

47 52 ⫾20.06 23M/24H 9⫾328.72

56 54 ⫾17.58 28M/28H 9⫾38.48

0.89 0.91 0.0004

7⫾ 62.21

1.5⫾9.95

0.007

9/47 (19.15%)

44/56 (78.58%)

⬍0.001

16/47 (34.04%)

35/56 (39.29%)

0.58

12/47 (25.53%)

16/56 (28.57%)

0.73

T1590 Incidence of Heterotopic Gastric Mucosa in the Upper Esophagus in First Time Narrow Banding Image Endoscopy of Consective 900 Patients Masanori Ohara (Purpose)The reported prevalence of endoscopically diagnosed heterotopic gastric mucosa in the area of the upper esophageal sphincter varies from 0.1% to 10%. The frequency increased year by year. One of the reasons is progress of endoscopic instruments. Narrow banding image(NBI) system is new endoscopic technology to have optical image enhancement function,by which we can observe ectopic gastric mucosa in the esophagus more clearly. In a prospective study of the frequency and clinical importance of heterotopic gastric mucosa in the upper esophagus,900 consecutive patients,undergoing NBI endoscopy for various gastrointestinal complaint,were evaluated.(Patients and methods)From 2008.9 to 2009.10,900 consecutive patients,undergoing NBI esophagogastroduodenoscopy as a part of gastrointestinal tract evaluation,were carefully examined by one of us(OM) for heterotopic gastric mucosa at the upper esophagus. The age range was 18-97 years. All patients were Japanese. Identified heterotopic gastric mucosal patches at the upper esophagus were photographed,and biopsied in some cases. The biposy specimens were stained with hematoxylin and eosin,periodic acid-Schiff and several mucin immunochemically.(Results)One hundred and eighty nine of 900 patients(21%) werefound to have heterotopic gastric mucosal patches at the upper esophagus. The patches were found in 110 patients in male 481 patients,79 patients in female 419 patients. By age distinction,the patches were seen in 15 patients in 68 patients under 50 years old,33 patients in 50’s 117 patients, 41 patients in 60’s 218 patients,72 patients in 70’s 339 patients and 30 patients in 158 patients over 80 years old. The mostheterotopic gastric mucosal patches were 15. Multiple patches were seen in 80 cases,single patch was seen in 109 cases. Most of heterotopic gastric mucosa was located in the left or right side. There were few heterotopic gastric mucosal patches in the anterior or posterior wall. The biopsies were performed in 51 cases. There was no Helicobacter pylori. Intestinal metaplasia with MUC2 positive was seen in 29 cases.’Conclusions)The prevalence of heterotopic gastric mucosal patches in the upper esophagus was 21% by NBI endoscopy. The 21% prevalence is the highest in the previous

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