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Tu1301 8-Hour CE Versus 12-Hour CE in a Cohort of Hospitalized Patients Undergoing CE for Suspected Small Bowel Disorders
Abstracts
(1/24) and 0% (0/1), respectively. Only 1 Lg-f/F3 case was detected. PHG was found in 27 patients by EGD. The overall diagnostic yield of CE for PHG was 67% (18/27). There was no difference in diagnostic yield between cases of severe and mild PHG (78% vs 61%). The diagnostic yield for PHG in the whole stomach was significantly higher than that limited to the upper stomach (100% vs 47%, P⫽0.009). There was no association between CE transit time and diagnostic yield for EVs, GVs, or PHG. Conclusion: CE is reliable for diagnosis of EVs with Ls/Lm and/or F2/3, and PHG in the whole stomach.
Tu1301 8-Hour CE Versus 12-Hour CE in a Cohort of Hospitalized Patients Undergoing CE for Suspected Small Bowel Disorders Rafiul S. Islam*, Neal C. Patel, Jonathan a. Leighton, Michael D. Crowell, Shabana F. Pasha Mayo Clinic, Scottsdale, AZ Background: Capsule endoscopy (CE) is a non-invasive test that is effective in the diagnosis of small bowel (SB) disorders. One of the main limitations of the 8-hour Pillcam SB2 (8H CE) is failure to reach the cecum and potential to miss lesions in the distal SB, especially in hospitalized patients. A 12-hour Pillcam SB2 CE (12H CE) with a prolonged battery life was introduced to overcome this limitation. Aim: The aim of this study was to compare the diagnostic yield and completion rates of 8H CE and 12H CE in a cohort of hospitalized patients. Secondary aims were to determine patient characteristics associated with an incomplete CE examination and to determine an association with the type of lesions found and its location on CE. Methods: The CE database at our institution was retrospectively reviewed from January 1st, 2009- July 30th 2012 for demographic and CE data on hospitalized patients who had undergone a 12H CE versus 8H CE. Univariate associations between variables were assessed using Chi-square tests and logistic regression. Significance levels were evaluated at the 0.05 level. Results: A total of 109 hospital patients underwent 8H CE and 54 patients underwent a 12H CE. CE was placed with EGD in 16 patients. The cohorts were not significantly different in gender, obesity, narcotic use, or diabetes (Table 1). Common indications for CE included obscure overt gastrointestinal bleed in 113 (69%) and iron deficiency anemia in 34 (21%) patients. The 12H CE was associated with higher diagnostic yield compared with the 8H CE (67% vs 47%, p⫽.017). The completion rates between 12H and 8H CE were not significantly different (87% vs 83%, p⫽0.54). The median (range) time for the 12H CE to reach the cecum was 311 (53 - 462) mins versus 267 (16 - 804) mins for the 8H CE (P ⫽ 0.199). The unadjusted odds of having an incomplete CE examination was 2.87 (95% CI, 1.02, 8.11; P ⫽ 0.046) for non-obese compared with obese patients. Adjustment for gender did not substantially change these findings. There was no association for an incomplete CE examination with diabetes, narcotic use, or motility disorders. There was a significant difference in the type of lesions found within a particular area of the small bowel (Table 2). Overall, detection of AVMs was significantly higher in the jejunum (57%), polyps/masses in the ileum (52%) and inflammatory lesions were found throughout the SB, p⫽.008. There was no difference between the 12H and 8H CE in detection of subtype of lesions or their location in the SB. Conclusion: In hospitalized patients, the 12 CE has a significantly higher diagnostic yield compared with the 8H CE, even though there was no difference in completion rates between the two capsules. An incomplete exam was more common in nonobese patients but was not influenced by diabetes, narcotic use, motility disorders, or gender. Table 1. Demographics of 8H vs 12H populations (nⴝ163) Characteristics (%) Males Obese Narcotic Use Diabetes Positive Diagnostic Yield Completion Rate
8 Hour CE
12 Hour CE
p-value
66 (60%) 44 (41%) 20 (18%) 36 (33%) 51 (47%) 91(87%)
35 (64%) 17 (32%) 11 (20%) 14 (25%) 36 (67%) 47(83%)
p⫽0.59 p⫽0.30 p⫽0.75 p⫽0.35 p⫽0.017 p⫽0.54
Table 2. Location of lesions
AVM Inflammatory Lesions Polyps/Masses P⫽.008
Duodenum
Jejunum
Ileum
12 (34%) 10 (40%) 2 (11%)
20 (57%) 8 (32%) 6 (35%)
3 (8%) 7 (28%) 9 (53%)
Tu1302 Benefit of Pronase in Image Quality in Magnifying Endoscopy With Narrow Band Imaging;a Preliminary Study Yu Kyung Cho*1, Gwang HA Kim2, Jae Myung Cha3, Sun-Young Lee4, IL-Kwun Chung5 1 The Catholic University College of Medicine, Seoul, Republic of Korea; 2 Pusan National University School of Medicine, Pusan, Republic of Korea; 3Kyung Hee University Hospital at Gang Dong, Seoul, Republic of Korea; 4Konkuk University Medical Center, Seoul, Republic of Korea; 5 Soonchunhyang University, Cheonan, Republic of Korea Background: Magnifying endoscopy with narrow band imaging (NBI) is useful for evaluating early gastric cancer or adenoma. However, artifacts caused by gastric mucus may worsen visibility during magnifying endoscopy. There has been no data about usefulness of mucolytic enzyme in magnifying endoscopic imaging. We aimed to investigate the efficacy of premedication with pronase, the proteolytic enzyme, for improving imaging during magnifying endoscopy with NBI. Methods: The study was designed as a blinded, randomized, prospective study and involved 59 patients with EGC or gastric adenoma scheduled for endoscopy. Patients were assigned to oral premedication with simethicone (control, N⫽30), or pronase, bicarbonate, and simethicone (N⫽29). First, gastric cavity obscurity grades (1-4) were assessed by using visibility scores from routine endoscopy in antrum, upper body, lower body and fundus,respectively. After that, the endoscopist used as many flushes of water using a 30 mL syringe necessary to get a satisfactory NBI-magnifying endoscopic view in antrum, body, and fundus. Main outcomes were numbers of water flush and times taken for NBI-magnifying endoscopy procedure. Secondary outcome was gastric visibility scores (1-4) during endoscopy. Lower scores indicate better visibility of the gastric mucosal surface. Results: In most patients, NBI- magnifying endoscopy view was satisfactory without mucus (26 pronase group vs. 15 control) or not disturbed in spite of remnant mucus (2 pronase group vs. 11 control). Significantly fewer flushes were used (0.7⫾ 0.8 times [0-2] vs. 2.4 ⫾ 1.5 times [0-6], p ⬍0.05) and less time was taken for NBI-magnifying endoscopy (271⫾188 vs. 408⫾217 sec, p⬍ 0.05) in pronase group. Total gastric cavity visibility score was also less in pronase group (5.1 ⫾ 6.7 vs.9.8⫾ 2.3, p⬍0.05). Conclusions: Premedication with pronase, the proteolytic enzyme, made magnifying endoscopy with NBI a more clear imaging and less time consuming procedure.
Tu1303 Risk Factors for Short-Term Complications of PerOral Endoscopic Myotomy (POEM) for Achalasia En Qiang Ling Hu*, Huikai LI Gastroenterology and Hepatology, The Chinese PLA General Hospital, Beijing, China Background and Study Aims: Peroral endoscopic myotomy (POEM) has been confirmed effective for achalasia in the short term,but complications were not uncommon.This study aimed to determine the risk factors for short-term complications of POEM. Methods: Data of patients with achalasia was reviewed who underwent POEM in our hospital.Complications rates were compared between groups of patients divided based on possible risk factors like sex, age, history of prior invasive treatment, type of tunnel entry incision, morphology of the esophagus especially its tortuousness, operation time, duration of symptoms, LESP and the date of POEM.Logistic regression analysis was used for statistical evaluation. Results: Among the 42 patients,22 were male and 20 female with a mean age of 40yr ranging from 22 to 62yr.POEM was successfully performed in all the 42 patients.Short-term complications were observed in 19.0% of the patients,including 2 patients with unilateral pneumothorax,3 patients with mucosal perforation,6 patients with subcutaneous emphysema and 3 patients with pneumomediastinum and/or pneumoperitoneum.Of all the risk factors included in the multivariate statistical model, age,operation time and transverse incision were significantly associated with the occurrence of complication Conclusions: Age,operation time and transverse incision were significantly associated with short-term complications of POEM.Key words Risk factor;shortterm;complication;peroral endoscopic myotomy;achalasia Multivariate analysis of risk factors for complications associated with POEM Risk factor
Odds Ratio (95% CI)
P value
Age Operation time Prior treatment Early operations Transverse incision Tortuousness LESP Symptom duration
49.93 (1.22,2049.15) 0.01 (0.00,0.65) 12.20 (0.28,532.26 ) 0.05 (0.00,1.80) 0.01 (0.00,0.62) 0.35 (0.02,8.35) 0.49 (0.02,11.05) 3.33 (0.12,93.27)
0.039 (⬍0.05) 0.031 (⬍0.05) 0.194 (NS) 0.102 (NS) 0.028 (⬍0.05) 0.518 (NS) 0.651 (NS) 0.479 (NS)
NS denotes not significant,LESP denotes lower esophageal sphincter pressure.
AB492 GASTROINTESTINAL ENDOSCOPY Volume 77, No. 5S : 2013
www.giejournal.org
(1/24) and 0% (0/1), respectively. Only 1 Lg-f/F3 case was detected. PHG was found in 27 patients by EGD. The overall diagnostic yield of CE for PHG was 67% (18/27). There was no difference in diagnostic yield between cases of severe and mild PHG (78% vs 61%). The diagnostic yield for PHG in the whole stomach was significantly higher than that limited to the upper stomach (100% vs 47%, P⫽0.009). There was no association between CE transit time and diagnostic yield for EVs, GVs, or PHG. Conclusion: CE is reliable for diagnosis of EVs with Ls/Lm and/or F2/3, and PHG in the whole stomach.
Tu1301 8-Hour CE Versus 12-Hour CE in a Cohort of Hospitalized Patients Undergoing CE for Suspected Small Bowel Disorders Rafiul S. Islam*, Neal C. Patel, Jonathan a. Leighton, Michael D. Crowell, Shabana F. Pasha Mayo Clinic, Scottsdale, AZ Background: Capsule endoscopy (CE) is a non-invasive test that is effective in the diagnosis of small bowel (SB) disorders. One of the main limitations of the 8-hour Pillcam SB2 (8H CE) is failure to reach the cecum and potential to miss lesions in the distal SB, especially in hospitalized patients. A 12-hour Pillcam SB2 CE (12H CE) with a prolonged battery life was introduced to overcome this limitation. Aim: The aim of this study was to compare the diagnostic yield and completion rates of 8H CE and 12H CE in a cohort of hospitalized patients. Secondary aims were to determine patient characteristics associated with an incomplete CE examination and to determine an association with the type of lesions found and its location on CE. Methods: The CE database at our institution was retrospectively reviewed from January 1st, 2009- July 30th 2012 for demographic and CE data on hospitalized patients who had undergone a 12H CE versus 8H CE. Univariate associations between variables were assessed using Chi-square tests and logistic regression. Significance levels were evaluated at the 0.05 level. Results: A total of 109 hospital patients underwent 8H CE and 54 patients underwent a 12H CE. CE was placed with EGD in 16 patients. The cohorts were not significantly different in gender, obesity, narcotic use, or diabetes (Table 1). Common indications for CE included obscure overt gastrointestinal bleed in 113 (69%) and iron deficiency anemia in 34 (21%) patients. The 12H CE was associated with higher diagnostic yield compared with the 8H CE (67% vs 47%, p⫽.017). The completion rates between 12H and 8H CE were not significantly different (87% vs 83%, p⫽0.54). The median (range) time for the 12H CE to reach the cecum was 311 (53 - 462) mins versus 267 (16 - 804) mins for the 8H CE (P ⫽ 0.199). The unadjusted odds of having an incomplete CE examination was 2.87 (95% CI, 1.02, 8.11; P ⫽ 0.046) for non-obese compared with obese patients. Adjustment for gender did not substantially change these findings. There was no association for an incomplete CE examination with diabetes, narcotic use, or motility disorders. There was a significant difference in the type of lesions found within a particular area of the small bowel (Table 2). Overall, detection of AVMs was significantly higher in the jejunum (57%), polyps/masses in the ileum (52%) and inflammatory lesions were found throughout the SB, p⫽.008. There was no difference between the 12H and 8H CE in detection of subtype of lesions or their location in the SB. Conclusion: In hospitalized patients, the 12 CE has a significantly higher diagnostic yield compared with the 8H CE, even though there was no difference in completion rates between the two capsules. An incomplete exam was more common in nonobese patients but was not influenced by diabetes, narcotic use, motility disorders, or gender. Table 1. Demographics of 8H vs 12H populations (nⴝ163) Characteristics (%) Males Obese Narcotic Use Diabetes Positive Diagnostic Yield Completion Rate
8 Hour CE
12 Hour CE
p-value
66 (60%) 44 (41%) 20 (18%) 36 (33%) 51 (47%) 91(87%)
35 (64%) 17 (32%) 11 (20%) 14 (25%) 36 (67%) 47(83%)
p⫽0.59 p⫽0.30 p⫽0.75 p⫽0.35 p⫽0.017 p⫽0.54
Table 2. Location of lesions
AVM Inflammatory Lesions Polyps/Masses P⫽.008
Duodenum
Jejunum
Ileum
12 (34%) 10 (40%) 2 (11%)
20 (57%) 8 (32%) 6 (35%)
3 (8%) 7 (28%) 9 (53%)
Tu1302 Benefit of Pronase in Image Quality in Magnifying Endoscopy With Narrow Band Imaging;a Preliminary Study Yu Kyung Cho*1, Gwang HA Kim2, Jae Myung Cha3, Sun-Young Lee4, IL-Kwun Chung5 1 The Catholic University College of Medicine, Seoul, Republic of Korea; 2 Pusan National University School of Medicine, Pusan, Republic of Korea; 3Kyung Hee University Hospital at Gang Dong, Seoul, Republic of Korea; 4Konkuk University Medical Center, Seoul, Republic of Korea; 5 Soonchunhyang University, Cheonan, Republic of Korea Background: Magnifying endoscopy with narrow band imaging (NBI) is useful for evaluating early gastric cancer or adenoma. However, artifacts caused by gastric mucus may worsen visibility during magnifying endoscopy. There has been no data about usefulness of mucolytic enzyme in magnifying endoscopic imaging. We aimed to investigate the efficacy of premedication with pronase, the proteolytic enzyme, for improving imaging during magnifying endoscopy with NBI. Methods: The study was designed as a blinded, randomized, prospective study and involved 59 patients with EGC or gastric adenoma scheduled for endoscopy. Patients were assigned to oral premedication with simethicone (control, N⫽30), or pronase, bicarbonate, and simethicone (N⫽29). First, gastric cavity obscurity grades (1-4) were assessed by using visibility scores from routine endoscopy in antrum, upper body, lower body and fundus,respectively. After that, the endoscopist used as many flushes of water using a 30 mL syringe necessary to get a satisfactory NBI-magnifying endoscopic view in antrum, body, and fundus. Main outcomes were numbers of water flush and times taken for NBI-magnifying endoscopy procedure. Secondary outcome was gastric visibility scores (1-4) during endoscopy. Lower scores indicate better visibility of the gastric mucosal surface. Results: In most patients, NBI- magnifying endoscopy view was satisfactory without mucus (26 pronase group vs. 15 control) or not disturbed in spite of remnant mucus (2 pronase group vs. 11 control). Significantly fewer flushes were used (0.7⫾ 0.8 times [0-2] vs. 2.4 ⫾ 1.5 times [0-6], p ⬍0.05) and less time was taken for NBI-magnifying endoscopy (271⫾188 vs. 408⫾217 sec, p⬍ 0.05) in pronase group. Total gastric cavity visibility score was also less in pronase group (5.1 ⫾ 6.7 vs.9.8⫾ 2.3, p⬍0.05). Conclusions: Premedication with pronase, the proteolytic enzyme, made magnifying endoscopy with NBI a more clear imaging and less time consuming procedure.
Tu1303 Risk Factors for Short-Term Complications of PerOral Endoscopic Myotomy (POEM) for Achalasia En Qiang Ling Hu*, Huikai LI Gastroenterology and Hepatology, The Chinese PLA General Hospital, Beijing, China Background and Study Aims: Peroral endoscopic myotomy (POEM) has been confirmed effective for achalasia in the short term,but complications were not uncommon.This study aimed to determine the risk factors for short-term complications of POEM. Methods: Data of patients with achalasia was reviewed who underwent POEM in our hospital.Complications rates were compared between groups of patients divided based on possible risk factors like sex, age, history of prior invasive treatment, type of tunnel entry incision, morphology of the esophagus especially its tortuousness, operation time, duration of symptoms, LESP and the date of POEM.Logistic regression analysis was used for statistical evaluation. Results: Among the 42 patients,22 were male and 20 female with a mean age of 40yr ranging from 22 to 62yr.POEM was successfully performed in all the 42 patients.Short-term complications were observed in 19.0% of the patients,including 2 patients with unilateral pneumothorax,3 patients with mucosal perforation,6 patients with subcutaneous emphysema and 3 patients with pneumomediastinum and/or pneumoperitoneum.Of all the risk factors included in the multivariate statistical model, age,operation time and transverse incision were significantly associated with the occurrence of complication Conclusions: Age,operation time and transverse incision were significantly associated with short-term complications of POEM.Key words Risk factor;shortterm;complication;peroral endoscopic myotomy;achalasia Multivariate analysis of risk factors for complications associated with POEM Risk factor
Odds Ratio (95% CI)
P value
Age Operation time Prior treatment Early operations Transverse incision Tortuousness LESP Symptom duration
49.93 (1.22,2049.15) 0.01 (0.00,0.65) 12.20 (0.28,532.26 ) 0.05 (0.00,1.80) 0.01 (0.00,0.62) 0.35 (0.02,8.35) 0.49 (0.02,11.05) 3.33 (0.12,93.27)
0.039 (⬍0.05) 0.031 (⬍0.05) 0.194 (NS) 0.102 (NS) 0.028 (⬍0.05) 0.518 (NS) 0.651 (NS) 0.479 (NS)
NS denotes not significant,LESP denotes lower esophageal sphincter pressure.
AB492 GASTROINTESTINAL ENDOSCOPY Volume 77, No. 5S : 2013
www.giejournal.org