- Email: [email protected]
Tu1226 Colon Capsule Endoscopy for Small Bowel Evaluation in Crohn's Disease
normal LVEF (>55%), EDV was elevated (>75 ml) in 62% patients where as ESV was increased (>30 ml) in 37.9% by 2-D echocardiography, however 6.9% patients had lower LVEF ( < 49%) whereas 27.5% and 13.8% of patients had elevated EDV ( > 86ml) and ESV ( > 41ml) respectively by real time 3-D echocardiography. CONCLUSION- 2-D echocardiography tends to overestimate LVEF & LV volume in cirrhotic patients. Real time 3-D echocardiography is more accurate for quantification of LV parameters, thereby helps in early detection of cardiac dysfunction in cirrhotic patients.
Tu1224 Intra-Operative Use of Impedance Planimetry During Surgery for Fecal Incontinence Ahmed Farag, John O'Dea
Tu1226
Introduction The EndoFLIP system (Crospon, Galway, Ireland) is a new imaging technology for measuring the cross sectional area of hollow organs in vivo. Previous publications have described the characterization of the anal sphincters in normal subjects, and subjects with Fecal Incontinence (FI).To date the system has not been used intra-operatively during sphincter repair or augmentation. We document here the first use of EndoFLIP for intraoperative evaluation of sphincter geometry and tightness during surgery. Methods and Procedures Prior to surgery, an EF-325N catheter was inserted, guided by finger into the rectum, such that approximately 2cm of the measurement area was outside the anal verge. As the balloon measures 8cm of lumen length, the sphincter region was readily discernible from the rectum at one end and the outside of the anal verge at the other. Figure 1 shows the sphincteric profile of the anal sphincter of the female subject with imperforate anus versus a normal continent female measured the same day. The top of the image represents the rectum and the bottom of the image is outside the anal verge. With 30mL in the balloon, the length of the sphincter region was seen to be approximately 3cm, but with a distensibility over 4.5 times that of the normal continent patient (4.3 versus 0.9 mm2/mmHg). Results Anal sphincter reconstruction was undertaken using unilateral gluteus maximus transposition. The EndoFLIP catheter was then re-inserted and the geometry of the sphincter region remeasured with 30mL in the balloon. The effect of the repair versus the pre-operative measurement is shown in Figure 2. Whereas the diameter of the region is not as low as a normal subject (8.5 versus 5.5mm), it is significantly reduced versus the pre-operative state (11.6mm minimum diameter). Moreover, the distensibility of the sphincter region was reduced after surgery from 4.3 to 2.9 mm2/mmHg. Greater tightening was observed in the inner anal sphincter versus the external anal sphincter. Conclusion This case study is the first reported use of intra-operative measurement during colorectal surgery with EndoFLIP. The catheter is easily deployed and provides a new quantitative means for assessing the degree of anal sphincter repair surgery for FI. Further work is underway to assess how such newly available measurements may integrated into our FI functional score methodology based on the flow equation and continence nomogram.
Colon Capsule Endoscopy for Small Bowel Evaluation in Crohn's Disease Begoña Gonzalez Suarez, Cristina Rodriguez de Miguel, Cristina Romero, Ingrid Ordás, Aranzazu Jauregui-Amezaga, Elena Ricart, Anna Ramirez, Marta Gallego, Gloria Fernandez-Esparrach, Angels Gines, Josep Llach, Julian Panes Second generation of Colon Capsule Endoscopy (Pillcam CCE 2) has a wider viewing angle and an adaptive frame rate to allow 36 frames per second on whole intestine. This change can suppose a higher diagnosis yield in some patients. Aim: To assess the diagnostic yield of CCE in the evaluation of small bowel in patients with Crohn's disease (CD) compared to Small Bowel Capsule Endoscopy (SBCE) with a lower frame rate (2 frames per second). Patients and Methods: Patients with diagnosed or suspected CD were submitted to CCE or SBCE since October 2011 to 2013. Number of findings detected, cleansing grade, Lewis Score, diagnosis yield and rate of complete studies were analyzed. Results: 66 patients were included (21 men and 45 women) with established (n=37) or suspected CD (n=29). 41 patients were submitted to SBCE and 25 CCE. We analyze small bowel pictures. Cleansing rate was significantly higher in patients submitted CCE than SBCE (100% vs 73% goodexcellent; p=0.025). There were no differences between gastric transit time (45, 60 +/-43.42 vs 44.19+/-56, 2 minutes) but Intestinal transit time was significantly lower in CCE patients. Rate of complete studies were higher too after CCE (100% vs 85%; p=0.004). Regarding number of findings, Lewis Score, diagnostic yield and complications there were no differences between both capsules. There were no differences in reading time. Conclusion: CCE is an innovative and non-invasive technic. Its use in Crohn's Disease patients for small bowel evaluation doesn't increase the diagnostic yield compared with SBCE but rate of complete studies and small bowel cleansing is significantly higher. Tu1227 Effect of Oral Administration of Methylene Blue MMx® Tablets on DoubleStranded DNA Damage Assessed by γH2AX Analysis of Colon Biopsy Samples - A Single Center, Open Label, Safety, Phase II Study Alessandro Repici, Mara Gerloni, Caridad Rosette, Camilla Ciscato, Michael Wallace, Alberto Malesci, Prateek Sharma, Silvio Danese, Ralf Kiesslich Background: Colonoscopy with methylene blue (MB) or other dyes (i.e. chromoendoscopy) is a technique that has been shown to improve adenoma detection and characterize colonic surface and polyp pit patterns. However, safety concerns have been raised regarding the use of MB for endoscopic procedures, as some studies have suggested MB can induce DNA damage when exposed to white light (in colorectal cancer cell lines), and in vivo (Barrett's oesophagus and ulcerative colitis biopsy samples), (Davies 2007, Olliver 2003). In the past, measurement of the amount of DNA double strand breaks has been performed with assays such as pulsed field gel electrophoresis and comet assays. Recently, detection of γH2AX has been shown to be considerably more sensitive, efficient, and reproducible compared to the previously reported techniques (Sedelnikova & Bonner 2006) in detection of DNA breaks. Aim: This study investigated if oral administration of Methylene Blue MMX®, followed by white light exposure of the mucosa during colonoscopy, may lead to DNA damage by the detection of γH2A. XMethods: Subjects undergoing 2 colonoscopies 2 weeks apart, for medical reasons, were prospectively enrolled for this study. During the initial standard white light colonoscopy, 5 control biopsies were obtained from the normal appearing mucosa 1 biopsy each from the 5 bowel regions; cecum, ascending, transverse, descending, sigmoidrectum. The second colonoscopy was preceded by the oral administration of 200 mg Methylene Blue MMX® tablets during the bowel prep time. Five biopsies were once again obtained from the same sites during the second colonoscopy-1 biopsy each in each from the 5 bowel regions; cecum, ascending, transverse, descending, sigmoid-rectum. γH2AX activity in colonic cells of all biopsy specimens taken before and after exposure to MB was evaluated by using γH2AX antibody staining with flow cytometry. Results: A total of 10 subjects were prospectively enrolled; mean age 58.7 years; 6 males. The mean number of days between the 1st and 2nd procedure was 11.4 days (range: 7-14days). All the tested samples did not show any signs of DNA damage and there were no differences between samples before and after MB mmx administration (Figures). Conclusion: In conclusion, , exposure of the colonic mucosa to MB and white light during standard colonoscopy did not show any evidence of DNA damage as evaluated by detection of γH2AX, that has been shown to be a more sensitive, efficient, and reproducible measure of DNA damage.
Figure 1 Comparison of anal sphincter region in the subject female patient versus a normal sphincter region
Figure 2 Comparison of anal sphincter region pre-operative and and post-operative Tu1225 Analysis of Left Ventricular Function by Two Dimensional & Real Time Three Dimensional Echocardiography in Cirrhotic Patients Satyarth Chaudhary, Mohd. T. Noor, Sunil Jain, siddhant jain, Mahendra Tilkar, Niraj K. Jain, Bhagwan S. Thakur AIM- To assess left ventricular ejection fraction & left ventricular volume by speckle imaging (real time 3-D echocardiography) and compare it with Simpson's (2-D echocardiography) in cirrhotic patients having normal ECG. BACKGROUND- Several recent studies have shown that real time 3-D echocardiography is superior to 2-D echocardiography for assessing left ventricular (LV) functions. However, no data is available for head to head comparison of 2-D echocardiography & real time 3-D echocardiography in cirrhotic patients. METHODTwenty nine patients of cirrhosis (20 male and 9 females) having normal ECG underwent detailed echocardiographic evaluation (General Electric, Vivid E 9). Apical four, two and three-chamber views were obtained in digital format for analysis. Apical views were tracked by speckle imaging. Biplane end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction(EF) were calculated by speckle imaging and Simpson's rule. Data was analysed using SPSS software. RESULTS-Mean age of presentation was 48.74 ±11.06 years. Alcohol (51.7%) was the major cause of cirrhosis in our study.LV functions estimated were significantly higher by 2-D echocardiography as compared to real time 3-D echocardiography[EDV (89.85 ± 29.27 vs 79.96 ± 28.29 ml, p = 0.034), ESV (28.58 ± 12.20 vs 31.15 ± 11.98 ml, p = 0.239), EF (68.19 ± 6.77 vs 61.08 ± 6.96 %, p = 0.001)]. All patients had
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AGA Abstracts
AGA Abstracts
adrenal incidentaloma, which was also observed in NCCT. Conclusions: NCCT might be sufficient to detect life threatening or significant disease requiring early treatment in young adults with biliary pain.
Tu1224 Intra-Operative Use of Impedance Planimetry During Surgery for Fecal Incontinence Ahmed Farag, John O'Dea
Tu1226
Introduction The EndoFLIP system (Crospon, Galway, Ireland) is a new imaging technology for measuring the cross sectional area of hollow organs in vivo. Previous publications have described the characterization of the anal sphincters in normal subjects, and subjects with Fecal Incontinence (FI).To date the system has not been used intra-operatively during sphincter repair or augmentation. We document here the first use of EndoFLIP for intraoperative evaluation of sphincter geometry and tightness during surgery. Methods and Procedures Prior to surgery, an EF-325N catheter was inserted, guided by finger into the rectum, such that approximately 2cm of the measurement area was outside the anal verge. As the balloon measures 8cm of lumen length, the sphincter region was readily discernible from the rectum at one end and the outside of the anal verge at the other. Figure 1 shows the sphincteric profile of the anal sphincter of the female subject with imperforate anus versus a normal continent female measured the same day. The top of the image represents the rectum and the bottom of the image is outside the anal verge. With 30mL in the balloon, the length of the sphincter region was seen to be approximately 3cm, but with a distensibility over 4.5 times that of the normal continent patient (4.3 versus 0.9 mm2/mmHg). Results Anal sphincter reconstruction was undertaken using unilateral gluteus maximus transposition. The EndoFLIP catheter was then re-inserted and the geometry of the sphincter region remeasured with 30mL in the balloon. The effect of the repair versus the pre-operative measurement is shown in Figure 2. Whereas the diameter of the region is not as low as a normal subject (8.5 versus 5.5mm), it is significantly reduced versus the pre-operative state (11.6mm minimum diameter). Moreover, the distensibility of the sphincter region was reduced after surgery from 4.3 to 2.9 mm2/mmHg. Greater tightening was observed in the inner anal sphincter versus the external anal sphincter. Conclusion This case study is the first reported use of intra-operative measurement during colorectal surgery with EndoFLIP. The catheter is easily deployed and provides a new quantitative means for assessing the degree of anal sphincter repair surgery for FI. Further work is underway to assess how such newly available measurements may integrated into our FI functional score methodology based on the flow equation and continence nomogram.
Colon Capsule Endoscopy for Small Bowel Evaluation in Crohn's Disease Begoña Gonzalez Suarez, Cristina Rodriguez de Miguel, Cristina Romero, Ingrid Ordás, Aranzazu Jauregui-Amezaga, Elena Ricart, Anna Ramirez, Marta Gallego, Gloria Fernandez-Esparrach, Angels Gines, Josep Llach, Julian Panes Second generation of Colon Capsule Endoscopy (Pillcam CCE 2) has a wider viewing angle and an adaptive frame rate to allow 36 frames per second on whole intestine. This change can suppose a higher diagnosis yield in some patients. Aim: To assess the diagnostic yield of CCE in the evaluation of small bowel in patients with Crohn's disease (CD) compared to Small Bowel Capsule Endoscopy (SBCE) with a lower frame rate (2 frames per second). Patients and Methods: Patients with diagnosed or suspected CD were submitted to CCE or SBCE since October 2011 to 2013. Number of findings detected, cleansing grade, Lewis Score, diagnosis yield and rate of complete studies were analyzed. Results: 66 patients were included (21 men and 45 women) with established (n=37) or suspected CD (n=29). 41 patients were submitted to SBCE and 25 CCE. We analyze small bowel pictures. Cleansing rate was significantly higher in patients submitted CCE than SBCE (100% vs 73% goodexcellent; p=0.025). There were no differences between gastric transit time (45, 60 +/-43.42 vs 44.19+/-56, 2 minutes) but Intestinal transit time was significantly lower in CCE patients. Rate of complete studies were higher too after CCE (100% vs 85%; p=0.004). Regarding number of findings, Lewis Score, diagnostic yield and complications there were no differences between both capsules. There were no differences in reading time. Conclusion: CCE is an innovative and non-invasive technic. Its use in Crohn's Disease patients for small bowel evaluation doesn't increase the diagnostic yield compared with SBCE but rate of complete studies and small bowel cleansing is significantly higher. Tu1227 Effect of Oral Administration of Methylene Blue MMx® Tablets on DoubleStranded DNA Damage Assessed by γH2AX Analysis of Colon Biopsy Samples - A Single Center, Open Label, Safety, Phase II Study Alessandro Repici, Mara Gerloni, Caridad Rosette, Camilla Ciscato, Michael Wallace, Alberto Malesci, Prateek Sharma, Silvio Danese, Ralf Kiesslich Background: Colonoscopy with methylene blue (MB) or other dyes (i.e. chromoendoscopy) is a technique that has been shown to improve adenoma detection and characterize colonic surface and polyp pit patterns. However, safety concerns have been raised regarding the use of MB for endoscopic procedures, as some studies have suggested MB can induce DNA damage when exposed to white light (in colorectal cancer cell lines), and in vivo (Barrett's oesophagus and ulcerative colitis biopsy samples), (Davies 2007, Olliver 2003). In the past, measurement of the amount of DNA double strand breaks has been performed with assays such as pulsed field gel electrophoresis and comet assays. Recently, detection of γH2AX has been shown to be considerably more sensitive, efficient, and reproducible compared to the previously reported techniques (Sedelnikova & Bonner 2006) in detection of DNA breaks. Aim: This study investigated if oral administration of Methylene Blue MMX®, followed by white light exposure of the mucosa during colonoscopy, may lead to DNA damage by the detection of γH2A. XMethods: Subjects undergoing 2 colonoscopies 2 weeks apart, for medical reasons, were prospectively enrolled for this study. During the initial standard white light colonoscopy, 5 control biopsies were obtained from the normal appearing mucosa 1 biopsy each from the 5 bowel regions; cecum, ascending, transverse, descending, sigmoidrectum. The second colonoscopy was preceded by the oral administration of 200 mg Methylene Blue MMX® tablets during the bowel prep time. Five biopsies were once again obtained from the same sites during the second colonoscopy-1 biopsy each in each from the 5 bowel regions; cecum, ascending, transverse, descending, sigmoid-rectum. γH2AX activity in colonic cells of all biopsy specimens taken before and after exposure to MB was evaluated by using γH2AX antibody staining with flow cytometry. Results: A total of 10 subjects were prospectively enrolled; mean age 58.7 years; 6 males. The mean number of days between the 1st and 2nd procedure was 11.4 days (range: 7-14days). All the tested samples did not show any signs of DNA damage and there were no differences between samples before and after MB mmx administration (Figures). Conclusion: In conclusion, , exposure of the colonic mucosa to MB and white light during standard colonoscopy did not show any evidence of DNA damage as evaluated by detection of γH2AX, that has been shown to be a more sensitive, efficient, and reproducible measure of DNA damage.
Figure 1 Comparison of anal sphincter region in the subject female patient versus a normal sphincter region
Figure 2 Comparison of anal sphincter region pre-operative and and post-operative Tu1225 Analysis of Left Ventricular Function by Two Dimensional & Real Time Three Dimensional Echocardiography in Cirrhotic Patients Satyarth Chaudhary, Mohd. T. Noor, Sunil Jain, siddhant jain, Mahendra Tilkar, Niraj K. Jain, Bhagwan S. Thakur AIM- To assess left ventricular ejection fraction & left ventricular volume by speckle imaging (real time 3-D echocardiography) and compare it with Simpson's (2-D echocardiography) in cirrhotic patients having normal ECG. BACKGROUND- Several recent studies have shown that real time 3-D echocardiography is superior to 2-D echocardiography for assessing left ventricular (LV) functions. However, no data is available for head to head comparison of 2-D echocardiography & real time 3-D echocardiography in cirrhotic patients. METHODTwenty nine patients of cirrhosis (20 male and 9 females) having normal ECG underwent detailed echocardiographic evaluation (General Electric, Vivid E 9). Apical four, two and three-chamber views were obtained in digital format for analysis. Apical views were tracked by speckle imaging. Biplane end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction(EF) were calculated by speckle imaging and Simpson's rule. Data was analysed using SPSS software. RESULTS-Mean age of presentation was 48.74 ±11.06 years. Alcohol (51.7%) was the major cause of cirrhosis in our study.LV functions estimated were significantly higher by 2-D echocardiography as compared to real time 3-D echocardiography[EDV (89.85 ± 29.27 vs 79.96 ± 28.29 ml, p = 0.034), ESV (28.58 ± 12.20 vs 31.15 ± 11.98 ml, p = 0.239), EF (68.19 ± 6.77 vs 61.08 ± 6.96 %, p = 0.001)]. All patients had
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AGA Abstracts
AGA Abstracts
adrenal incidentaloma, which was also observed in NCCT. Conclusions: NCCT might be sufficient to detect life threatening or significant disease requiring early treatment in young adults with biliary pain.