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Tu1524 The Clinical Significance and Etiology of Lymphoid Follicular Proctitis
Abstracts
incomplete colonoscopy during the 4-month time period. The majority of patients were over age 50 (n⫽108), undergoing colonoscopy for polyp detection (n⫽112), and were outpatients (80.1%). Procedures were performed by 22 unique endoscopists (range 1-18 incomplete procedures per physician). The most common reasons for incomplete colonoscopy were endoscope looping (n⫽47), inadequate bowel preparation (n⫽32), tortuosity (n⫽25), and inadequate sedation (n⫽8). In 23 procedure notes (19%), no recommendation was made for complete colon evaluation (CCE). Specific recommendations were enumerated in 98 procedure notes (81.0%), with radiologic testing (n⫽53) and repeat colonoscopy with extended bowel preparation (n⫽21) most common. CCE was recommended immediately in 71 patients, within 1 year in 3 patients, and after 1 year in 24 patients. Incomplete procedures in which polyps were identified were more likely to have specified recommendations for CCE (95% vs. 78.4%, p⫽0.12) and for CCE to be recommended within 1 year (73.6% vs. 56.8%, p⫽0.2) compared to procedures without polyps seen. Incomplete procedures due to poor preparation were more likely to recommend CCE utilizing endoscopy than incomplete procedures due to endoscope looping/colon angulation (75.0% vs. 7.0%, p ⬍ .0001). Procedures in which the extent was distal to the hepatic flexure were more likely to have CCE recommended within 1 year compared to extent proximal to the hepatic flexure (69.1% vs. 50.9%, p⫽.06). In total, 57/74 patients adhered to the recommendation of CCE within 12 months. Adherence was similar regardless of modality of CCE recommended, inpatient/outpatient status, polyps on initial exam, or extent of initial exam. There was a trend towards lower adherence rates in African American’s (64.3%) compared to Caucasians (83.0%, p⫽0.26). Conclusions: Colonoscopists are more likely to recommend CCE on examinations that do not reach the hepatic flexure and when polyps are seen on initial incomplete exam. However, after incomplete colonoscopy, nearly 25% of patients do not undergo evaluation of the remaining colon within 12 months despite physician recommendation.
Tu1522 Can Hyperplasic-Serrated Lesions and Adenomatous Lesions Be Differentiated During a Conventional Colonoscopy? Predictive Features Based on Endoscopic Characteristics José M. Mella, Carolina Fischer, Raquel GonzáLez, Lisandro Pereyra, Guillermo Nicolás Panigadi, Adriana Mohaidle, Pablo Luna, Sandra Lencinas, Silvia C. Pedreira, Daniel G. Cimmino, Luis A. Boerr Hospital Alemán, Buenos Aires, Argentina Introduction. Colonic adenomas are well known as colorectal cancer precursors. Although serrated lesions are currently considered to present an increased risk of cancer, they are macroscopically similar to hyperplasic polyps, and therefore are usually mistaken. Aims: To analyze the endoscopic characteristics of the most frequent colonic lesions (hyperplasic, serrated and adenomas) using white-light colonoscopy, and to find out endoscopic predictors of hyperplasic-serrated lesions, which may help to differentiate them from adenomatous lesions. Material and methods: We analyzed all resected polyps in every colonoscopy performed in our Unit between May and August 2010. The following characteristics of colonic lesions were analyzed: morphology (sessile or flat vs pedunculated), size (⬍1cm vs ⱖ1cm), localization (right vs left colon), presence of mucus covering the lesion, and some combinations of this characteristics. The diagnosis of hyperplasic, serrated and adenomatous lesions was determined histopathologically. Hyperplasic and serrated lesions were analyzed together as a composite endpoint and compared with adenomatous lesions. Endoscopic characteristics significantly related to hyperplasic-serrated lesions were identified by univariate analysis (considering significant an odds ratio (OR) ⬍or⬎1 which confidence intervals (CI) 95% were ⫽ 1). Independent predictors for this group of lesions were also analyzed using a binary logistic regression model. Results: We prospectively analyzed 256 colonic lesions. Most of them were sessile (83%) and small (less than 1 cm, 77%); 52% were in the right colon and 12% had mucus on their surface. Histopathologically, 45% were hyperplasic-serrated lesions, and 55% were adenomas. By univariate analysis, we identified the following endoscopic characteristics to be associated with the diagnosis of hyperplastic-serrated lesions: location in the right colon OR 1.77 (CI 1.07-2.93), the presence of mucus OR 6.82 (CI 2.69-17.25), a flat or sessile morphology OR 11.2 (CI 1.44-87), right colon location and having mucus OR 8.88 (CI 2.97-26), the presence of mucus in lesions ⱖ 1 cm located in the right colon OR 12.3 (CI 1.53-98). By multivariate analyses, the only endoscopic feature independently associated with hyperplasic-serrated histology was the presence of mucus covering the lesion: OR 5.31 (CI 2.04-13.85). Discussion. These endoscopic characteristics, which can be easily obtained during a white-light colonoscopy, could be useful to identify hyperplasic-serrated lesions, and to encourage the pathologists to look for serrated features.
Tu1523 Evaluation of Subepithelial Lesion of the Appendix by Endoscopic Ultrasound Tae Hee Lee, Jin-Oh Kim, Hyun Gun Kim, Wan Jung Kim, Won Young Cho, Bong Min Ko, Joo Young Cho, Joon Seong Lee, Moon Sung Lee Institute for Digestive Research, Soonchunhyang University, Seoul, Republic of Korea Background: The use of through-the-scope (TTS) miniprobe catheter endoscopic ultrasound is a valuable technique for evaluating subepithelial lesions in the proximal colon. Few reports include the evaluation of the appendix by EUS. Objective: To evaluate the performance characteristics of EUS in the diagnosis of periappendiceal subepithelial lesions. Methods: Retrospective case series in a single academic medical center. Adult patients referred for evaluation of subepithelial lesions of the appendix identified by colonoscopy between January, 2004 to July, 2010. Data were abstracted from an endoscopic ultrasound database for all patients undergoing miniprobe endoscopic ultrasound examination of the appendix. Results: Fifteen cases were identified. Nine (60%) patients were male. EUS corrected presumptive endoscopic diagnosis in two cases(13%). A total of two cases were identified as being extrinsic compression of the small bowel. Presumptive diagnosis became to be certain in 10 cases(67%) after EUS exam. Surgery was needed in 5 cases on the basis of the presumptive EUS diagnosis. A total of 3 cases were confirmed histologically by surgery. Conclusions: EUS evaluation can improve diagnostic certainty of subepithelial lesions of the appendix. Furthermore it may assist in the selection of patients who may benefit from surgical management in the patients with subepithelial lesions of the appendix
Tu1524 The Clinical Significance and Etiology of Lymphoid Follicular Proctitis Junghyun Lee1, Byung Kook Kim1, So Dug Lim2, Kim Jeong Hwan1, Lee Sun-Young1, In Kyung Sung1, Hyung Seok Park1, Choon-Jo Jin1, Shim Chan Sup1 1 Digestive Disease Center, Konkuk University Medical Center, Seoul, Republic of Korea; 2Department of pathology, Konkuk University Medical Center, Seoul, Republic of Korea Background/aims: Lymphoid follicular proctitis is an uncommon inflammatory condition confined to the rectal mucosa. The aim of this study was to identify disease specific clinical, endoscopic, and histopathological findings, to aid the effective differential diagnosis of lymphoid follicular proctitis in the general population. Methods: This was a retrospective analysis of patients from our database who undergo colonoscopy and sigmoidoscopy by two expert endoscopists at Konkuk university hospital from May 2009 to July 2010. Diagnosis of lymphoid follicular proctitis was only based on endoscopic finding that is a striking finely granular pattern without erosions or ulcerations on the rectal mucosa. And then the clinical features, endoscopic findings and pathologic findings of 12 patients with lymphoid follicular proctitis were reviewed. Results: One thousand thirty nine patients underwent colonoscopy or sigmoidoscopy for 14 months. One hundred and three cases were excluded due to previous large bowel surgery, pancolitis, and a prior history of inflammatory bowel disease. Twenty patients(0.72%) were diagnosed as lymphoid follicular proctitis among the 1636 examinations. A retrospective review of lymphoid follicular proctitis showed the commonest cause is Chlamydia trachomatis infection(7 patients, 0.43%). This was followed by taking lipid lowering agent in 0.12%(2 patients), unknown etiology in 0.12%(2 patients), and allergic disorder in 0.06%(1 patient). Chlamydia proctitis is the most common cause of the lymphoid follicular proctitis in general population. Chlamydia proctitis is significantly related with pelvic inflammatory disease (PID) and/or Fitz-Hugh Curtis (FHC) syndrome. Six of 7 patients with chlamydia proctitis were successfully treated by oral azithromycin. Two patients with non-chlamydia proctitis taking lipid lowering agent were healed after switching to other lipid lowering agent. Conclusion: Lymphoid follicular proctitisis a rare disorder in non-homosexual person. Chlamydia infection is the most common cause of lymphoid follicular proctitis, especially in women of childbearing age who have PID and/or FHC syndrome.
Tu1525 “Clip and Loop” Technique for Endoscopic Resection of Large Pedunculated Polyps Pietro Fusaroli, Stefania Ferri, Stefania Fiorentini, Francesca Serotti, Mariangela Tattini, Rossella Callegari, Giancarlo G. Caletti University of Bologna; Dept. of Gastroenterology, Castel S. Pietro Terme, Italy Background: Colonoscopic polypectomy of large pedunculated polyps may be associated with complications such as bleeding. Use of a detachable snare (endoloop) may reduce the risk of bleeding but its application may be
AB436 GASTROINTESTINAL ENDOSCOPY Volume 73, No. 4S : 2011
www.giejournal.org
incomplete colonoscopy during the 4-month time period. The majority of patients were over age 50 (n⫽108), undergoing colonoscopy for polyp detection (n⫽112), and were outpatients (80.1%). Procedures were performed by 22 unique endoscopists (range 1-18 incomplete procedures per physician). The most common reasons for incomplete colonoscopy were endoscope looping (n⫽47), inadequate bowel preparation (n⫽32), tortuosity (n⫽25), and inadequate sedation (n⫽8). In 23 procedure notes (19%), no recommendation was made for complete colon evaluation (CCE). Specific recommendations were enumerated in 98 procedure notes (81.0%), with radiologic testing (n⫽53) and repeat colonoscopy with extended bowel preparation (n⫽21) most common. CCE was recommended immediately in 71 patients, within 1 year in 3 patients, and after 1 year in 24 patients. Incomplete procedures in which polyps were identified were more likely to have specified recommendations for CCE (95% vs. 78.4%, p⫽0.12) and for CCE to be recommended within 1 year (73.6% vs. 56.8%, p⫽0.2) compared to procedures without polyps seen. Incomplete procedures due to poor preparation were more likely to recommend CCE utilizing endoscopy than incomplete procedures due to endoscope looping/colon angulation (75.0% vs. 7.0%, p ⬍ .0001). Procedures in which the extent was distal to the hepatic flexure were more likely to have CCE recommended within 1 year compared to extent proximal to the hepatic flexure (69.1% vs. 50.9%, p⫽.06). In total, 57/74 patients adhered to the recommendation of CCE within 12 months. Adherence was similar regardless of modality of CCE recommended, inpatient/outpatient status, polyps on initial exam, or extent of initial exam. There was a trend towards lower adherence rates in African American’s (64.3%) compared to Caucasians (83.0%, p⫽0.26). Conclusions: Colonoscopists are more likely to recommend CCE on examinations that do not reach the hepatic flexure and when polyps are seen on initial incomplete exam. However, after incomplete colonoscopy, nearly 25% of patients do not undergo evaluation of the remaining colon within 12 months despite physician recommendation.
Tu1522 Can Hyperplasic-Serrated Lesions and Adenomatous Lesions Be Differentiated During a Conventional Colonoscopy? Predictive Features Based on Endoscopic Characteristics José M. Mella, Carolina Fischer, Raquel GonzáLez, Lisandro Pereyra, Guillermo Nicolás Panigadi, Adriana Mohaidle, Pablo Luna, Sandra Lencinas, Silvia C. Pedreira, Daniel G. Cimmino, Luis A. Boerr Hospital Alemán, Buenos Aires, Argentina Introduction. Colonic adenomas are well known as colorectal cancer precursors. Although serrated lesions are currently considered to present an increased risk of cancer, they are macroscopically similar to hyperplasic polyps, and therefore are usually mistaken. Aims: To analyze the endoscopic characteristics of the most frequent colonic lesions (hyperplasic, serrated and adenomas) using white-light colonoscopy, and to find out endoscopic predictors of hyperplasic-serrated lesions, which may help to differentiate them from adenomatous lesions. Material and methods: We analyzed all resected polyps in every colonoscopy performed in our Unit between May and August 2010. The following characteristics of colonic lesions were analyzed: morphology (sessile or flat vs pedunculated), size (⬍1cm vs ⱖ1cm), localization (right vs left colon), presence of mucus covering the lesion, and some combinations of this characteristics. The diagnosis of hyperplasic, serrated and adenomatous lesions was determined histopathologically. Hyperplasic and serrated lesions were analyzed together as a composite endpoint and compared with adenomatous lesions. Endoscopic characteristics significantly related to hyperplasic-serrated lesions were identified by univariate analysis (considering significant an odds ratio (OR) ⬍or⬎1 which confidence intervals (CI) 95% were ⫽ 1). Independent predictors for this group of lesions were also analyzed using a binary logistic regression model. Results: We prospectively analyzed 256 colonic lesions. Most of them were sessile (83%) and small (less than 1 cm, 77%); 52% were in the right colon and 12% had mucus on their surface. Histopathologically, 45% were hyperplasic-serrated lesions, and 55% were adenomas. By univariate analysis, we identified the following endoscopic characteristics to be associated with the diagnosis of hyperplastic-serrated lesions: location in the right colon OR 1.77 (CI 1.07-2.93), the presence of mucus OR 6.82 (CI 2.69-17.25), a flat or sessile morphology OR 11.2 (CI 1.44-87), right colon location and having mucus OR 8.88 (CI 2.97-26), the presence of mucus in lesions ⱖ 1 cm located in the right colon OR 12.3 (CI 1.53-98). By multivariate analyses, the only endoscopic feature independently associated with hyperplasic-serrated histology was the presence of mucus covering the lesion: OR 5.31 (CI 2.04-13.85). Discussion. These endoscopic characteristics, which can be easily obtained during a white-light colonoscopy, could be useful to identify hyperplasic-serrated lesions, and to encourage the pathologists to look for serrated features.
Tu1523 Evaluation of Subepithelial Lesion of the Appendix by Endoscopic Ultrasound Tae Hee Lee, Jin-Oh Kim, Hyun Gun Kim, Wan Jung Kim, Won Young Cho, Bong Min Ko, Joo Young Cho, Joon Seong Lee, Moon Sung Lee Institute for Digestive Research, Soonchunhyang University, Seoul, Republic of Korea Background: The use of through-the-scope (TTS) miniprobe catheter endoscopic ultrasound is a valuable technique for evaluating subepithelial lesions in the proximal colon. Few reports include the evaluation of the appendix by EUS. Objective: To evaluate the performance characteristics of EUS in the diagnosis of periappendiceal subepithelial lesions. Methods: Retrospective case series in a single academic medical center. Adult patients referred for evaluation of subepithelial lesions of the appendix identified by colonoscopy between January, 2004 to July, 2010. Data were abstracted from an endoscopic ultrasound database for all patients undergoing miniprobe endoscopic ultrasound examination of the appendix. Results: Fifteen cases were identified. Nine (60%) patients were male. EUS corrected presumptive endoscopic diagnosis in two cases(13%). A total of two cases were identified as being extrinsic compression of the small bowel. Presumptive diagnosis became to be certain in 10 cases(67%) after EUS exam. Surgery was needed in 5 cases on the basis of the presumptive EUS diagnosis. A total of 3 cases were confirmed histologically by surgery. Conclusions: EUS evaluation can improve diagnostic certainty of subepithelial lesions of the appendix. Furthermore it may assist in the selection of patients who may benefit from surgical management in the patients with subepithelial lesions of the appendix
Tu1524 The Clinical Significance and Etiology of Lymphoid Follicular Proctitis Junghyun Lee1, Byung Kook Kim1, So Dug Lim2, Kim Jeong Hwan1, Lee Sun-Young1, In Kyung Sung1, Hyung Seok Park1, Choon-Jo Jin1, Shim Chan Sup1 1 Digestive Disease Center, Konkuk University Medical Center, Seoul, Republic of Korea; 2Department of pathology, Konkuk University Medical Center, Seoul, Republic of Korea Background/aims: Lymphoid follicular proctitis is an uncommon inflammatory condition confined to the rectal mucosa. The aim of this study was to identify disease specific clinical, endoscopic, and histopathological findings, to aid the effective differential diagnosis of lymphoid follicular proctitis in the general population. Methods: This was a retrospective analysis of patients from our database who undergo colonoscopy and sigmoidoscopy by two expert endoscopists at Konkuk university hospital from May 2009 to July 2010. Diagnosis of lymphoid follicular proctitis was only based on endoscopic finding that is a striking finely granular pattern without erosions or ulcerations on the rectal mucosa. And then the clinical features, endoscopic findings and pathologic findings of 12 patients with lymphoid follicular proctitis were reviewed. Results: One thousand thirty nine patients underwent colonoscopy or sigmoidoscopy for 14 months. One hundred and three cases were excluded due to previous large bowel surgery, pancolitis, and a prior history of inflammatory bowel disease. Twenty patients(0.72%) were diagnosed as lymphoid follicular proctitis among the 1636 examinations. A retrospective review of lymphoid follicular proctitis showed the commonest cause is Chlamydia trachomatis infection(7 patients, 0.43%). This was followed by taking lipid lowering agent in 0.12%(2 patients), unknown etiology in 0.12%(2 patients), and allergic disorder in 0.06%(1 patient). Chlamydia proctitis is the most common cause of the lymphoid follicular proctitis in general population. Chlamydia proctitis is significantly related with pelvic inflammatory disease (PID) and/or Fitz-Hugh Curtis (FHC) syndrome. Six of 7 patients with chlamydia proctitis were successfully treated by oral azithromycin. Two patients with non-chlamydia proctitis taking lipid lowering agent were healed after switching to other lipid lowering agent. Conclusion: Lymphoid follicular proctitisis a rare disorder in non-homosexual person. Chlamydia infection is the most common cause of lymphoid follicular proctitis, especially in women of childbearing age who have PID and/or FHC syndrome.
Tu1525 “Clip and Loop” Technique for Endoscopic Resection of Large Pedunculated Polyps Pietro Fusaroli, Stefania Ferri, Stefania Fiorentini, Francesca Serotti, Mariangela Tattini, Rossella Callegari, Giancarlo G. Caletti University of Bologna; Dept. of Gastroenterology, Castel S. Pietro Terme, Italy Background: Colonoscopic polypectomy of large pedunculated polyps may be associated with complications such as bleeding. Use of a detachable snare (endoloop) may reduce the risk of bleeding but its application may be
AB436 GASTROINTESTINAL ENDOSCOPY Volume 73, No. 4S : 2011
www.giejournal.org