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Unsedated ultrathin EGD is well accepted by most patients: a randomized trial of unsedated Ultrathin EGD (UT-EGD) vs. sedated Conventional EGD (C-EGD)
S306
Abstracts
duodenum. 2) These mucosal defenses are blunted in smokers. 3) In this human study, endoscopic reflectance spectrophotometry confirms the adverse effect of smoking in the duodenal mucosa previously and exclusively reported in animal experiments.
AJG – Vol. 97, No. 9, Suppl., 2002
manner. Total procedure/recovery time was shorter in the unsedated group (Table). Baseline Characteristics and Outcomes
930 IS FNA BIOPSY USEFUL IN THE EUS EVALUATION OF ALL GASTRIC SUBMUCOSAL TUMORS? Michael Y. Li, M.D., Steven Kessler, M.D., Alan Heimann, M.D., Garry Maini and John W. Birk, M.D.*. Department of Gastroenterology and Hepatology, University Hospital SUNY–Stony Brook, Stony Brook, NY. Purpose: EUS is useful in evaluating gastric submucosal tumors. The addition of FNA biopsy can also add to the evaluation. However, an adequate tissue sample needs be obtained which is not always the case. The aim of this study is to investigate factors (e.g. tumor size or wall layer origin) that suggest successfully obtaining adequate tissue. Methods: FNA biopsies of gastric submucosal tumors done for 2 years were retrospectively analyzed. All biospies were obtained with a 22 gauge Medi–Globe needle using the Olympus GFUM–20 echoendoscope. Size of the tumor (⬍or ⬎ 2.0 cm) and wall layer of the origin (submucosa or muscularis) were compared by chi square analysis for success of obtaining adequate tissue. Results: Overall 16 cases were identified and positive tissue diagnoses were obtained in 44% (7/16). For lesions ⬍ 2cm, the success rate was 22% (2/9) vs lesions ⬎ 2 cm the success rate was 71% (5/7), the difference was statistically significant with p ⬍0.05. For the submucosal lesions, the success rate was 25% (2/8) vs muscularis lesions the success rate was 75% (6/8) which also statistically significant with p ⬍ 0.05. Conclusions: The EUS evaluation of gastric submucosal tumors includes both ultrasonographic characteristics and cytology obtained on FNA biopsy. Our study shows that it is less likely to obtain adequate tissue diagnosis in submucosal lesions and all lesions ⬍2 cm. These findings should be considered in the clinical management of all such lesions. 931 UNSEDATED ULTRATHIN EGD IS WELL ACCEPTED BY MOST PATIENTS: A RANDOMIZED TRIAL OF UNSEDATED ULTRATHIN EGD (UT–EGD) VS. SEDATED CONVENTIONAL EGD (C–EGD) Ruel T. Garcia, M.D., John P. Cello, M.D.*, Stanley J. Rogers, M.D., Alex Rodas, Mindie H. Nguyen, M.D., Huy Trinh, M.D., Neil H. Stollman, M.D. and Kenneth R. McQuaid, M.D. Division of Gastroenterology, University of California, San Francisco, San Francisco, CA; Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA and San Jose, CA. Purpose: To compare patient satisfaction with unsedated UT–EGD vs. sedated C–EGD. Methods: We performed a randomized, controlled, non– blinded trial comparing unsedated UT–EGD (peroral, 6 mm endoscope) vs sedated C–EGD (9 mm endoscope). Patients scheduled for routine diagnostic EGD were invited to participate. Outcome measures were overall patient satisfaction, patient comfort, endoscopy time, total procedure/recovery time and percentage of patients willing to repeat EGD in the same manner. Satisfaction and comfort were measured using a 10 cm visual analog scale (VAS) with 10 being the score of highest comfort and satisfaction. Comparison between the 2 study groups was done using Chi–square statistics for categorical variables and Kruskal–Wallis for continuous variables. Results: Of the 128 patients invited: 80 (63%) agreed to be randomized and 48 (37%) declined to participate (12 only wanted unsedated UT–EGD and 36 only wanted sedated C–EGD). Therefore, 92 of the invited patients (72%) were willing to undergo unsedated UT–EGD. Baseline characteristics of randomized patients were similar. Though comfort level was lower in unsedated patients, there were no statistically significant differences in overall patient satisfaction and willingness to undergo EGD in the same
Median (range) or % Age (Years) Male Actual EGD time (minutes) Total procedure/recovery time (minutes) Comfort score (VAS 0–10) Overall satisfaction (VAS 0–10) Willing to repeat in the same manner
Unsedated UT–EGD (nⴝ40)
Sedated C–EGD (nⴝ40)
P
50 (20–83) 68% 3.5 (1–13.5) 28 (15–125)
51 (28–83) 53% 5 (2.5–20) 112 (38–174)
0.06 0.17 0.011 0.0001
6.7 (0.4–9.9) 9.5 (5.2–10) 90%
9.4 (3.5–10) 9.4 (2.6–10) 95%
0.002 0.77 0.38
Conclusions: Most patients are willing to undergo unsedated EGD using the ultrathin endoscope. Patients undergoing unsedated UT–EGD were as satisfied as patients undergoing sedated C–EGD and were equally willing to repeat the procedure. Unsedated UT–EGD is an acceptable alternative to sedated EGD. 932 IMPACT OF ANESTHESIOLOGIST ON ENDOLUMINAL GASTROPLICATION (ELGP) PROCEDURE Julia J. Liu, M.D., Robert M. Knapp, D.O., John R. Saltzman, M.D., Mark T. Osterman, M.D. and David L. Carr–Locke, M.D.*. Endoscopy Unit, Brigham and Women’s Hospital, Boston, MA and Department of Anesthesia, Brigham and Women’s Hospital, Boston, MA. Purpose: Endoluminal gastroplication (ELGP) is an endoscopic treatment option for patients with GERD. There has been no previous study looking at the role of anesthesiologist and sedation in ELGP. We prospectively studied to examine the amount of sedative (propofol) used, duration of procedure and complication rate for ELGP by a dedicated or substitute anesthesiologists. Methods: One dedicated anesthesiologist with particular interest in providing anesthesia for patients undergoing ELGP developed a two stage anesthesia protocol consisting of first stage topical anesthesia and second stage intravenous propofol anesthesia using a standardized protocol. Substitute anesthesiologists were present for cases performed when the dedicated anesthesiologist was unavailable, and they were recommended to follow the same protocol. Results: A total of 43 procedures were performed over 8 months. There were 21 males, 22 female with a mean age of 46 years and a mean BMI of 28. The dedicated anesthesiologist performed 22 procedures without complications and 21 cases were performed by substitute anesthesiologists with two complications including one mucosal laceration and one aspiration pneumonia. The dedicated anesthesiologist used more propofol compared to substitute anesthesiologists (10⫹/– 4 mg/min vs. 7⫹/– 4 mg/min, p⫽0.03) and the duration of procedure was significantly shorter with the dedicated anesthesiologist (47⫹/–10 vs. 60⫹/–11 minutes, p⬍0.01). There were no differences in the age, gender, BMI or other patient characteristics for cases done by the assigned versus substitute anesthesiologists. Conclusions: A dedicated anesthesiologist significantly improves ELGP procedure flow leading to a significant reduction of procedure time and possibly reduces anesthesia–related complications. 933 SUCCESS OF PHYSICIAN VERSUS NONPHYSICIAN ENDOSCOPISTS IN PERFORMING SCREENING FLEXIBLE SIGMOIDOSCOPY IN THE ELDERLY POPULATION Ajay Pabby, M.D., Anupam Suneja, M.B.B.S.,M.P.H., Tim Heeren, Ph.D. and Francis A. Farraye, M.D., FACG*. Section of Gastroenterology, Boston Medical Center, Boston, MA; Department of Geriatrics, Boston Medical Center, Boston, MA and Boston University School of Public Health, Boston, MA.
Abstracts
duodenum. 2) These mucosal defenses are blunted in smokers. 3) In this human study, endoscopic reflectance spectrophotometry confirms the adverse effect of smoking in the duodenal mucosa previously and exclusively reported in animal experiments.
AJG – Vol. 97, No. 9, Suppl., 2002
manner. Total procedure/recovery time was shorter in the unsedated group (Table). Baseline Characteristics and Outcomes
930 IS FNA BIOPSY USEFUL IN THE EUS EVALUATION OF ALL GASTRIC SUBMUCOSAL TUMORS? Michael Y. Li, M.D., Steven Kessler, M.D., Alan Heimann, M.D., Garry Maini and John W. Birk, M.D.*. Department of Gastroenterology and Hepatology, University Hospital SUNY–Stony Brook, Stony Brook, NY. Purpose: EUS is useful in evaluating gastric submucosal tumors. The addition of FNA biopsy can also add to the evaluation. However, an adequate tissue sample needs be obtained which is not always the case. The aim of this study is to investigate factors (e.g. tumor size or wall layer origin) that suggest successfully obtaining adequate tissue. Methods: FNA biopsies of gastric submucosal tumors done for 2 years were retrospectively analyzed. All biospies were obtained with a 22 gauge Medi–Globe needle using the Olympus GFUM–20 echoendoscope. Size of the tumor (⬍or ⬎ 2.0 cm) and wall layer of the origin (submucosa or muscularis) were compared by chi square analysis for success of obtaining adequate tissue. Results: Overall 16 cases were identified and positive tissue diagnoses were obtained in 44% (7/16). For lesions ⬍ 2cm, the success rate was 22% (2/9) vs lesions ⬎ 2 cm the success rate was 71% (5/7), the difference was statistically significant with p ⬍0.05. For the submucosal lesions, the success rate was 25% (2/8) vs muscularis lesions the success rate was 75% (6/8) which also statistically significant with p ⬍ 0.05. Conclusions: The EUS evaluation of gastric submucosal tumors includes both ultrasonographic characteristics and cytology obtained on FNA biopsy. Our study shows that it is less likely to obtain adequate tissue diagnosis in submucosal lesions and all lesions ⬍2 cm. These findings should be considered in the clinical management of all such lesions. 931 UNSEDATED ULTRATHIN EGD IS WELL ACCEPTED BY MOST PATIENTS: A RANDOMIZED TRIAL OF UNSEDATED ULTRATHIN EGD (UT–EGD) VS. SEDATED CONVENTIONAL EGD (C–EGD) Ruel T. Garcia, M.D., John P. Cello, M.D.*, Stanley J. Rogers, M.D., Alex Rodas, Mindie H. Nguyen, M.D., Huy Trinh, M.D., Neil H. Stollman, M.D. and Kenneth R. McQuaid, M.D. Division of Gastroenterology, University of California, San Francisco, San Francisco, CA; Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA and San Jose, CA. Purpose: To compare patient satisfaction with unsedated UT–EGD vs. sedated C–EGD. Methods: We performed a randomized, controlled, non– blinded trial comparing unsedated UT–EGD (peroral, 6 mm endoscope) vs sedated C–EGD (9 mm endoscope). Patients scheduled for routine diagnostic EGD were invited to participate. Outcome measures were overall patient satisfaction, patient comfort, endoscopy time, total procedure/recovery time and percentage of patients willing to repeat EGD in the same manner. Satisfaction and comfort were measured using a 10 cm visual analog scale (VAS) with 10 being the score of highest comfort and satisfaction. Comparison between the 2 study groups was done using Chi–square statistics for categorical variables and Kruskal–Wallis for continuous variables. Results: Of the 128 patients invited: 80 (63%) agreed to be randomized and 48 (37%) declined to participate (12 only wanted unsedated UT–EGD and 36 only wanted sedated C–EGD). Therefore, 92 of the invited patients (72%) were willing to undergo unsedated UT–EGD. Baseline characteristics of randomized patients were similar. Though comfort level was lower in unsedated patients, there were no statistically significant differences in overall patient satisfaction and willingness to undergo EGD in the same
Median (range) or % Age (Years) Male Actual EGD time (minutes) Total procedure/recovery time (minutes) Comfort score (VAS 0–10) Overall satisfaction (VAS 0–10) Willing to repeat in the same manner
Unsedated UT–EGD (nⴝ40)
Sedated C–EGD (nⴝ40)
P
50 (20–83) 68% 3.5 (1–13.5) 28 (15–125)
51 (28–83) 53% 5 (2.5–20) 112 (38–174)
0.06 0.17 0.011 0.0001
6.7 (0.4–9.9) 9.5 (5.2–10) 90%
9.4 (3.5–10) 9.4 (2.6–10) 95%
0.002 0.77 0.38
Conclusions: Most patients are willing to undergo unsedated EGD using the ultrathin endoscope. Patients undergoing unsedated UT–EGD were as satisfied as patients undergoing sedated C–EGD and were equally willing to repeat the procedure. Unsedated UT–EGD is an acceptable alternative to sedated EGD. 932 IMPACT OF ANESTHESIOLOGIST ON ENDOLUMINAL GASTROPLICATION (ELGP) PROCEDURE Julia J. Liu, M.D., Robert M. Knapp, D.O., John R. Saltzman, M.D., Mark T. Osterman, M.D. and David L. Carr–Locke, M.D.*. Endoscopy Unit, Brigham and Women’s Hospital, Boston, MA and Department of Anesthesia, Brigham and Women’s Hospital, Boston, MA. Purpose: Endoluminal gastroplication (ELGP) is an endoscopic treatment option for patients with GERD. There has been no previous study looking at the role of anesthesiologist and sedation in ELGP. We prospectively studied to examine the amount of sedative (propofol) used, duration of procedure and complication rate for ELGP by a dedicated or substitute anesthesiologists. Methods: One dedicated anesthesiologist with particular interest in providing anesthesia for patients undergoing ELGP developed a two stage anesthesia protocol consisting of first stage topical anesthesia and second stage intravenous propofol anesthesia using a standardized protocol. Substitute anesthesiologists were present for cases performed when the dedicated anesthesiologist was unavailable, and they were recommended to follow the same protocol. Results: A total of 43 procedures were performed over 8 months. There were 21 males, 22 female with a mean age of 46 years and a mean BMI of 28. The dedicated anesthesiologist performed 22 procedures without complications and 21 cases were performed by substitute anesthesiologists with two complications including one mucosal laceration and one aspiration pneumonia. The dedicated anesthesiologist used more propofol compared to substitute anesthesiologists (10⫹/– 4 mg/min vs. 7⫹/– 4 mg/min, p⫽0.03) and the duration of procedure was significantly shorter with the dedicated anesthesiologist (47⫹/–10 vs. 60⫹/–11 minutes, p⬍0.01). There were no differences in the age, gender, BMI or other patient characteristics for cases done by the assigned versus substitute anesthesiologists. Conclusions: A dedicated anesthesiologist significantly improves ELGP procedure flow leading to a significant reduction of procedure time and possibly reduces anesthesia–related complications. 933 SUCCESS OF PHYSICIAN VERSUS NONPHYSICIAN ENDOSCOPISTS IN PERFORMING SCREENING FLEXIBLE SIGMOIDOSCOPY IN THE ELDERLY POPULATION Ajay Pabby, M.D., Anupam Suneja, M.B.B.S.,M.P.H., Tim Heeren, Ph.D. and Francis A. Farraye, M.D., FACG*. Section of Gastroenterology, Boston Medical Center, Boston, MA; Department of Geriatrics, Boston Medical Center, Boston, MA and Boston University School of Public Health, Boston, MA.