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Tu1348 Comparison of Self-Expandable Metallic Stent Placement for Acute Colorectal Obstruction Caused by Extracolonic Malignancy and Colorectal Cancer
Abstracts
Tu1347 Feasibility of Surgicel® Fibrillar™ in Patient With Colonic Postpolypectomy Bleeding: a Pilot Study Bong MIN Ko*1, Moon Han Choi1, Hyun Gun Kim2, Seong Ran Jeon2, Su Jin Hong1, Jong Ho Moon1, Jin-OH Kim2, Joo Young Cho2, Moon Sung Lee1 1 Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Republic of Korea; 2Department of Internal Medicine, Soonchunhyang University School of Medicine, Seoul, Republic of Korea Backgrounds: The various endoscopic procedures are performed for the treatment of postprocedural bleeding after polypectomy. The endoscopic hemoclipping is used most commonly but its cost is expensive. The purpose of this study is to evaluate the feasibility of surgicel® Fibrillar™ as an alternative hemostatic agent which is inexpensive and easily used. Methods: Between September 2011 and September 2012, 3254 consecutive patients who underwent the endoscopic polypectomy in colon were reviewed. The hemostatic procedures such as endoscopic hemoclipping or application of surgicel were performed in patient with post polypectomy bleeding. For the confirmation of hemostasis in cases of application of surgicel, the follow-up colonoscopies were carried out in some cases. Results: There were 85 cases (2.61%) of postprocedural bleeding after polypectomy out of 3254 patients. Of these, 33 subjects (38.8%) underwent endoscopic hemoclipping, while 52 (61.2%) were treated with the application of surgicel. In 48(92.3%) cases from those of immediate bleeding, hemostasis was achieved successfully but delayed bleeding was occurred in one (2.1%) case out of these 52 cases and controlled with endoscopic hemoclipping. The follow-up colonoscopies were performed in 23 cases out of 52 patients who were treated with the surgicel. Conclusions: Endoscopic management of postpolypectomy bleeding by surgicel provides hemostasis in the great majority of cases. Therefore surgicel may use for the hemostasis in patient with colonic postpolypectomy bleeding. For more accurate evaluation of the hemostatic effect of surgicel® Fibrillar™ and comparison it to other hemostatic procedures, a prospective study and a larger series of cases are required.
Figure 1. Kaplan-Meier analysis of 1-year survival for colorectal cancer (CRC) group and extracolonic malignancies (ECM) group.
Tu1348 Comparison of Self-Expandable Metallic Stent Placement for Acute Colorectal Obstruction Caused by Extracolonic Malignancy and Colorectal Cancer Jiamin Zhou, Yunshi Zhong*, Meidong Xu, Pinghong Zhou, Weifeng Chen, Qiang Shi, Zhong Ren, Tao Chen, Liqing Yao zhongshan Hospital, Fudan University, Shanghai, China Objective: The present study aimed to evaluate the safety, efficacy and prognosis of SEMS placement in patients with acute colorectal obstruction (ACO) caused by extracolonic malignancies (ECM). Methods: Success rate, complications and survival time of totally 109 patients, from November 2006 to April 2012, with ACO caused by metastatic or recurrent colorectal cancer (CRC) (n ⫽ 96) or by ECM (n ⫽ 13) respectively undergoing palliative SEMS placement were evaluated retrospectively. Results: ECM group included 8 gastric cancers, 3 gynecologic cancers, 1 bladder cancer and 1 pelvic inflammatory myofibroblastic tumor. The technical success rate was 100% in both of ECM group and CRC group. There was no significant difference in clinical success rate between these two groups (77.0% vs 83.3%, P ⫽ 0.696). The stent patency time was also equal between the two groups (117 ⫾ 148.8 vs 188.2 ⫾ 203.6, P ⫽ 0.230). Stent related complications in ECM group were 2 reobstruction and 1 migration. One patient’s symptom was not relieved. 30-day mortality (7.8% vs 12.5%, P ⫽ 1.000), 1-year survival (short-term) and overall survival (lont-term) were also equal between these two groups (P ⫽ 0.140 and P ⫽ 0.282; Fig. 1 and Fig. 2). Conclusions: The safety and effectiveness of SEMS placement in patients with ACO caused by ECM is comparable to that in patients with ACO caused by metastatic or recurrent CRC. It may be an appropriate option for treating malignant ACO.
Figure 2. Kaplan-Meier analysis of overall survival for colorectal cancer (CRC) group and extracolonic malignancies (ECM) group.
Tu1349 Mucosal Healing in Patients With Crohn’s Disease During Scheduled Infliximab Maintenance Therapy Initiated Following Surgical Resection of Active Lesions Akihiro Yamada*, Ken Takeuchi, Yasuo Suzuki Sakura Hospital, Sakura, Japan Background: Crohn’s disease (CD) is a chronic relapsing-remitting inflammatory bowel disorder with variable disease expression, giving rise to multiple complications like abdominal discomfort, diarrhoea, fever, anaemia and weight loss. CD can affect any part of the digestive track from the mouth to the perianal region and up to 65% of patients may have CD affecting the small intestine. Infliximab (IFX) is an anti-tumour necrosis factor-␣ antibody, which has been used to induce remission in patients with active CD. Further, given its efficacy in active CD, IFX is now applied as maintenance therapy to sustain remission. However, examinations of endoscopic images indicate that during maintenance IFX, complete mucosal healing is not achieved and that disease activity continues including the formation of intestinal strictures. Methods: With the afore background in mind, we thought that IFX maintenance therapy should maintain complete remission (including mucosal healing) if administered immediately following surgical resection of active CD lesions, which we called Re-set IFX therapy. A total of 63 patients were divided into two groups, routine IFX group (RIFX, n⫽30 and Re-set IFX group (Re-set IFX, n⫽33). In the RIFX group, patients received IFX therapy to induce remission of CD that had relapsed
www.giejournal.org
Volume 77, No. 5S : 2013
GASTROINTESTINAL ENDOSCOPY
AB509
Tu1347 Feasibility of Surgicel® Fibrillar™ in Patient With Colonic Postpolypectomy Bleeding: a Pilot Study Bong MIN Ko*1, Moon Han Choi1, Hyun Gun Kim2, Seong Ran Jeon2, Su Jin Hong1, Jong Ho Moon1, Jin-OH Kim2, Joo Young Cho2, Moon Sung Lee1 1 Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Republic of Korea; 2Department of Internal Medicine, Soonchunhyang University School of Medicine, Seoul, Republic of Korea Backgrounds: The various endoscopic procedures are performed for the treatment of postprocedural bleeding after polypectomy. The endoscopic hemoclipping is used most commonly but its cost is expensive. The purpose of this study is to evaluate the feasibility of surgicel® Fibrillar™ as an alternative hemostatic agent which is inexpensive and easily used. Methods: Between September 2011 and September 2012, 3254 consecutive patients who underwent the endoscopic polypectomy in colon were reviewed. The hemostatic procedures such as endoscopic hemoclipping or application of surgicel were performed in patient with post polypectomy bleeding. For the confirmation of hemostasis in cases of application of surgicel, the follow-up colonoscopies were carried out in some cases. Results: There were 85 cases (2.61%) of postprocedural bleeding after polypectomy out of 3254 patients. Of these, 33 subjects (38.8%) underwent endoscopic hemoclipping, while 52 (61.2%) were treated with the application of surgicel. In 48(92.3%) cases from those of immediate bleeding, hemostasis was achieved successfully but delayed bleeding was occurred in one (2.1%) case out of these 52 cases and controlled with endoscopic hemoclipping. The follow-up colonoscopies were performed in 23 cases out of 52 patients who were treated with the surgicel. Conclusions: Endoscopic management of postpolypectomy bleeding by surgicel provides hemostasis in the great majority of cases. Therefore surgicel may use for the hemostasis in patient with colonic postpolypectomy bleeding. For more accurate evaluation of the hemostatic effect of surgicel® Fibrillar™ and comparison it to other hemostatic procedures, a prospective study and a larger series of cases are required.
Figure 1. Kaplan-Meier analysis of 1-year survival for colorectal cancer (CRC) group and extracolonic malignancies (ECM) group.
Tu1348 Comparison of Self-Expandable Metallic Stent Placement for Acute Colorectal Obstruction Caused by Extracolonic Malignancy and Colorectal Cancer Jiamin Zhou, Yunshi Zhong*, Meidong Xu, Pinghong Zhou, Weifeng Chen, Qiang Shi, Zhong Ren, Tao Chen, Liqing Yao zhongshan Hospital, Fudan University, Shanghai, China Objective: The present study aimed to evaluate the safety, efficacy and prognosis of SEMS placement in patients with acute colorectal obstruction (ACO) caused by extracolonic malignancies (ECM). Methods: Success rate, complications and survival time of totally 109 patients, from November 2006 to April 2012, with ACO caused by metastatic or recurrent colorectal cancer (CRC) (n ⫽ 96) or by ECM (n ⫽ 13) respectively undergoing palliative SEMS placement were evaluated retrospectively. Results: ECM group included 8 gastric cancers, 3 gynecologic cancers, 1 bladder cancer and 1 pelvic inflammatory myofibroblastic tumor. The technical success rate was 100% in both of ECM group and CRC group. There was no significant difference in clinical success rate between these two groups (77.0% vs 83.3%, P ⫽ 0.696). The stent patency time was also equal between the two groups (117 ⫾ 148.8 vs 188.2 ⫾ 203.6, P ⫽ 0.230). Stent related complications in ECM group were 2 reobstruction and 1 migration. One patient’s symptom was not relieved. 30-day mortality (7.8% vs 12.5%, P ⫽ 1.000), 1-year survival (short-term) and overall survival (lont-term) were also equal between these two groups (P ⫽ 0.140 and P ⫽ 0.282; Fig. 1 and Fig. 2). Conclusions: The safety and effectiveness of SEMS placement in patients with ACO caused by ECM is comparable to that in patients with ACO caused by metastatic or recurrent CRC. It may be an appropriate option for treating malignant ACO.
Figure 2. Kaplan-Meier analysis of overall survival for colorectal cancer (CRC) group and extracolonic malignancies (ECM) group.
Tu1349 Mucosal Healing in Patients With Crohn’s Disease During Scheduled Infliximab Maintenance Therapy Initiated Following Surgical Resection of Active Lesions Akihiro Yamada*, Ken Takeuchi, Yasuo Suzuki Sakura Hospital, Sakura, Japan Background: Crohn’s disease (CD) is a chronic relapsing-remitting inflammatory bowel disorder with variable disease expression, giving rise to multiple complications like abdominal discomfort, diarrhoea, fever, anaemia and weight loss. CD can affect any part of the digestive track from the mouth to the perianal region and up to 65% of patients may have CD affecting the small intestine. Infliximab (IFX) is an anti-tumour necrosis factor-␣ antibody, which has been used to induce remission in patients with active CD. Further, given its efficacy in active CD, IFX is now applied as maintenance therapy to sustain remission. However, examinations of endoscopic images indicate that during maintenance IFX, complete mucosal healing is not achieved and that disease activity continues including the formation of intestinal strictures. Methods: With the afore background in mind, we thought that IFX maintenance therapy should maintain complete remission (including mucosal healing) if administered immediately following surgical resection of active CD lesions, which we called Re-set IFX therapy. A total of 63 patients were divided into two groups, routine IFX group (RIFX, n⫽30 and Re-set IFX group (Re-set IFX, n⫽33). In the RIFX group, patients received IFX therapy to induce remission of CD that had relapsed
www.giejournal.org
Volume 77, No. 5S : 2013
GASTROINTESTINAL ENDOSCOPY
AB509