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W1057 Safety and Efficacy of Carbon Dioxide Insufflation During Endoscopic Submucosal Dissection of Large Polyps and Early Cancers of the GI Tract: A Retrospective Analysis
(44 Segments). Conclusions: PET-CT colonography is a promising noninvasive technique for assessment of disease extent in patients with ulcerative colitis.
AGA Abstracts
W1054 Radiofrequency Ablation with BARRx Halo90 Effectively Treated Chronic Radiation Proctitis As Confirmed with Endoscopic Three-Dimensional Optical Coherence Tomography Chao Zhou, Desmond C. Adler, Laren Becker, Yu Chen, Tsung-Han Tsai, Hsiang-Chieh Lee, Marisa Figueiredo, Joseph M. Schmitt, Qin Huang, James G. Fujimoto, Hiroshi Mashimo W1056
BACKGROUND: Chronic radiation proctitis (CRP) is a long-term complication of pelvic radiotherapy. Argon plasma coagulation and bipolar electrocautery are current hemostatic treatments for CRP, but ulcerations, re-bleeding and strictures frequently occur. Endoscopic three-dimensional optical coherence tomography (3D-OCT) was used for follow-up assessment of RFA treatment to evaluate the presence of neo-squamous epithelium and subsurface vessels. METHODS: Five patients with bleeding from CRP were treated with RFA using the BARRX Halo90 system. Two patients previously failed therapy with argon plasma coagulation, and one patient previously failed therapy with electocautery. Patients were imaged with standard endoscopy and 3D-OCT before and after the RFA treatment. 3D-OCT volumes with less than 10 μm resolution were obtained with a spiral-scanning catheter over an 8 x 18 x 1.8 mm region in 20 seconds. RESULTS: In all cases, the procedure was well-tolerated and hemostasis was achieved after 1 or 2 RFA sessions. Excellent re-epithelialization and absence of ulcerations or strictures was observed following the RFA treatment up to 19 months. Ectatic blood vessels observed over areas of prior hemorrhage were effectively removed. Vascular structure could be differentiated from focal glands or cysts by sectioning through the volumetric data set and tracking vessel patterns. Follow-up images over visible ablation area with neo-squamous layer showed no evidence of underlying large ectatic vessels. CONCLUSIONS: 3D-OCT provides large-area volumetric subsurface imaging of tissue microstructure In-Vivo. 3D-OCT, used in conjunction with standard endoscopy, is a uniquely suited modality for assessing treatment of CRP, especially since excisional biopsies must be avoided in these relatively ischemic regions which are prone to re-bleeding and heal poorly.
Air Volume in the Gut in Normal Human Subjects Measured By Computed Tomography: Determination of Normal Values and Validation of the Technique Mariaelena Serio, Lorenzo Migliorato, Mariangela Spezzaferro, Flora Sacco, Brunella Cerasa, Laurino Grossi, Leonardo Marzio Introduction Abdominal bloating due to excessive air in the gut is one the most common complain in patients affected by irritable bowel syndrome. The determination of the amount of air in the abdomen is not yet standardized and normal values are not known. With computed tomography (CT) the air in the gut may be easily seen and volume quantified through dedicated computer software. Aim To test the validity of the air volume measured by abdominal CT and to quantify the air present into the gut lumen in a group of normal subjects . Material and methods. Twenty patients (15M, 5F, mean age 54±12 yrs) undergoing CT scan of the spine for back pain and without abdominal complains were studied. Each patient was scanned with abdominal CT in basal condition after 12 hours fasting, and subsequently after the introduction of 500 ml and 1000ml of room air through a graduated syringe connected to an intra-rectal catheter used for barium enema. The volume of gas within the gut was measured considering the x-ray attenuation of air and water using Hounsfield Unit (HU) as reference, where the attenuation produced by pure air is - 1000 HU and the attenuation of water is 0 HU. The program allows a calculation of the total gas volume within the abdominal cavity and measurements of segmental volumes in selected regions of the gut. Absolute values and delta values from basal were calculated and correlation coefficient computed. Measurements were performed by one of us (L Mi) unaware of the air introduced. Results Basal air volume into the gut in the 20 subjects examined was found to be 321±82 ml (mean±SEM). After the introduction of 500 ml of air the mean value of air increased to 898 ±95 and after 1000 ml this valued increased to 1942±179 ml (R= 0.987). Delta values from basal were: 576± 65 after 500 ml and 1044± 106 after 1000 ml (r=0.9980). Conclusion:It is concluded that with CT scan the volume of air into the whole gut can be reliably measured and that basal air in our normal subjects is around 300 ml. W1057 Safety and Efficacy of Carbon Dioxide Insufflation During Endoscopic Submucosal Dissection of Large Polyps and Early Cancers of the GI Tract: A Retrospective Analysis Wilson P. Pais, Seema S. Tekwani, Priyanka Tiwari, Nicholas M. Szary, Matthew L. Bechtold, Jamal A. Ibdah, John B. Marshall, Mainor R. Antillon
A, En face projection from 3D-OCT at 14-month post RFA. Inset, endoscopic image shows squamous neo-epithelium covering previous site of ectatic vessels. B and C, Cross sectional views at locations marked by blue and red dashed lines. Scale bars, 1mm.
Background: Carbon dioxide (CO2) insufflation has been known to reduce abdominal pain and discomfort in gastrointestinal (GI) endoscopic procedures and laparoscopic surgery. The safety and efficacy of using CO2 is unclear in prolonged GI procedures such as endoscopic submucosal dissection (ESD) of GI neoplasms. The aim of this study was to assess the safety and efficacy of CO2 insufflation during ESD involving the upper and lower GI tract. Methods: Retrospective analysis of outcomes of CO2 versus room air insufflation in 115 patients undergoing upper and lower GI tract ESD procedures (36 patients in the CO2 group from 2/08-11/08 versus 79 patients in the room air insufflation group from 6/06-2/08). All ESDs were performed by a single experienced endoscopist (MRA). Both groups underwent the procedure supported by anesthesia and surgical backup (where applicable). Results: The locations of the lesions in the CO2 group consisted of 24 colonic, 7 rectal, 3 esophageal, 1 gastric, and 1 duodenal while the room air group consisted of 40 colonic, 16 rectal, 6 esophageal, and 17 duodenal. The mean size of GI lesions were similar between the two groups (3.65 versus 4.10 cm, p=0.18). The CO2 group demonstrated a statistically significant shorter procedure time (85.11 versus 106.67 minutes, p=0.03) as compared to the room air group. Also, the CO2 group showed a trend, although not statistically significant, toward a better en-bloc resection rate (94.4 versus 84.8%, p=0.07) and a reduction in perforation rate (2.8 versus 10.1%, p=0.09). No statistically significant difference was noted between the two groups for bleeding rates (2.8 versus 3.8%, p=0.39). The median length of hospital stay for the CO2 and room air group was one day each. Conclusion: CO2 insufflation may be a better alternative to room air insufflation in ESD due to the decrease in procedure times. Also, CO2 insufflation demonstrated a trend toward increased en-bloc removal of the lesions and decreased perforation rate. Further larger studies are needed to demonstrate the superiority of CO2 insufflation during ESD, especially for en-bloc resection and perforation rates.
W1055 Diagnostic Testing Complementary for Diagnosing Ileal Pouch Disorders Linda Y. Tang, Hui Cai, Bo Shen, Lauren Moore Background & Aim: Various imaging techniques have been used to assess ileal pouch disorders including CT enterography (CTE), gastrograffin enema (GGE), magnetic resonance imaging (MRI) and pouch endoscopy (PES). The purpose of this study is to evaluate the effectiveness of these imaging techniques as compared to the gold standard of the final diagnosis made by all the tests combined. Methods: 66 patients from the Pouchitis Clinic at the Cleveland Clinic who had a PES and at least one other imaging modality (CTE, GGE or MRI) were included in the study. We analyzed the accuracy of these tests to diagnose inlet strictures, outlet strictures, fistulas, sinus disease and cancer in our patient population. Results: In total, 66 patients underwent evaluation with PES (N=66), CTE (N=23), GGE (N=34) and MRI (N=26). The mean age was 41.5±14.5 years. There were 28 females (42.4%). 60 patients (90.9%) had J pouches and 59 patients (89.4%) had a preoperative diagnosis of ulcerative colitis (rather than indeterminate colitis). Conclusions: CTE had a lower accuracy in diagnosing inlet stricture than GGE, MRI or PES. MRI was less accurate in diagnosis of sinus disease. Overall, these modalities appear to be complementary and each has their strength in the diagnostic paradigm. Table 1. Correlation of PES with other Diagnostic Tests
W1058 Table 2: Accuracy of Diagnostic Tests
Patient Satisfaction and Endoscopic Visibility of Two Colonic Lavage Solutions: A Comparison Rogier J. De Ridder, Silvia Sanduleanu, Gwen Masclee, Yolande Keulemans, Wim Hameeteman, Ad Masclee Background : New endoscopic techniques have been introduced to further improve diagnostic accuracy of colonoscopy. In this respect optimal cleansing of the colon is crucial while patient burden of lavage should be minimal. Aim: To assess the efficacy and patient satisfaction of a new colon cleansing product polyethylene glycole (PEG 3350, 3 Litres, without sodium sulphate, Endofalk®) compared to the standard preparation (PEG 3350, containing sodium
AGA Abstracts
A-644
AGA Abstracts
W1054 Radiofrequency Ablation with BARRx Halo90 Effectively Treated Chronic Radiation Proctitis As Confirmed with Endoscopic Three-Dimensional Optical Coherence Tomography Chao Zhou, Desmond C. Adler, Laren Becker, Yu Chen, Tsung-Han Tsai, Hsiang-Chieh Lee, Marisa Figueiredo, Joseph M. Schmitt, Qin Huang, James G. Fujimoto, Hiroshi Mashimo W1056
BACKGROUND: Chronic radiation proctitis (CRP) is a long-term complication of pelvic radiotherapy. Argon plasma coagulation and bipolar electrocautery are current hemostatic treatments for CRP, but ulcerations, re-bleeding and strictures frequently occur. Endoscopic three-dimensional optical coherence tomography (3D-OCT) was used for follow-up assessment of RFA treatment to evaluate the presence of neo-squamous epithelium and subsurface vessels. METHODS: Five patients with bleeding from CRP were treated with RFA using the BARRX Halo90 system. Two patients previously failed therapy with argon plasma coagulation, and one patient previously failed therapy with electocautery. Patients were imaged with standard endoscopy and 3D-OCT before and after the RFA treatment. 3D-OCT volumes with less than 10 μm resolution were obtained with a spiral-scanning catheter over an 8 x 18 x 1.8 mm region in 20 seconds. RESULTS: In all cases, the procedure was well-tolerated and hemostasis was achieved after 1 or 2 RFA sessions. Excellent re-epithelialization and absence of ulcerations or strictures was observed following the RFA treatment up to 19 months. Ectatic blood vessels observed over areas of prior hemorrhage were effectively removed. Vascular structure could be differentiated from focal glands or cysts by sectioning through the volumetric data set and tracking vessel patterns. Follow-up images over visible ablation area with neo-squamous layer showed no evidence of underlying large ectatic vessels. CONCLUSIONS: 3D-OCT provides large-area volumetric subsurface imaging of tissue microstructure In-Vivo. 3D-OCT, used in conjunction with standard endoscopy, is a uniquely suited modality for assessing treatment of CRP, especially since excisional biopsies must be avoided in these relatively ischemic regions which are prone to re-bleeding and heal poorly.
Air Volume in the Gut in Normal Human Subjects Measured By Computed Tomography: Determination of Normal Values and Validation of the Technique Mariaelena Serio, Lorenzo Migliorato, Mariangela Spezzaferro, Flora Sacco, Brunella Cerasa, Laurino Grossi, Leonardo Marzio Introduction Abdominal bloating due to excessive air in the gut is one the most common complain in patients affected by irritable bowel syndrome. The determination of the amount of air in the abdomen is not yet standardized and normal values are not known. With computed tomography (CT) the air in the gut may be easily seen and volume quantified through dedicated computer software. Aim To test the validity of the air volume measured by abdominal CT and to quantify the air present into the gut lumen in a group of normal subjects . Material and methods. Twenty patients (15M, 5F, mean age 54±12 yrs) undergoing CT scan of the spine for back pain and without abdominal complains were studied. Each patient was scanned with abdominal CT in basal condition after 12 hours fasting, and subsequently after the introduction of 500 ml and 1000ml of room air through a graduated syringe connected to an intra-rectal catheter used for barium enema. The volume of gas within the gut was measured considering the x-ray attenuation of air and water using Hounsfield Unit (HU) as reference, where the attenuation produced by pure air is - 1000 HU and the attenuation of water is 0 HU. The program allows a calculation of the total gas volume within the abdominal cavity and measurements of segmental volumes in selected regions of the gut. Absolute values and delta values from basal were calculated and correlation coefficient computed. Measurements were performed by one of us (L Mi) unaware of the air introduced. Results Basal air volume into the gut in the 20 subjects examined was found to be 321±82 ml (mean±SEM). After the introduction of 500 ml of air the mean value of air increased to 898 ±95 and after 1000 ml this valued increased to 1942±179 ml (R= 0.987). Delta values from basal were: 576± 65 after 500 ml and 1044± 106 after 1000 ml (r=0.9980). Conclusion:It is concluded that with CT scan the volume of air into the whole gut can be reliably measured and that basal air in our normal subjects is around 300 ml. W1057 Safety and Efficacy of Carbon Dioxide Insufflation During Endoscopic Submucosal Dissection of Large Polyps and Early Cancers of the GI Tract: A Retrospective Analysis Wilson P. Pais, Seema S. Tekwani, Priyanka Tiwari, Nicholas M. Szary, Matthew L. Bechtold, Jamal A. Ibdah, John B. Marshall, Mainor R. Antillon
A, En face projection from 3D-OCT at 14-month post RFA. Inset, endoscopic image shows squamous neo-epithelium covering previous site of ectatic vessels. B and C, Cross sectional views at locations marked by blue and red dashed lines. Scale bars, 1mm.
Background: Carbon dioxide (CO2) insufflation has been known to reduce abdominal pain and discomfort in gastrointestinal (GI) endoscopic procedures and laparoscopic surgery. The safety and efficacy of using CO2 is unclear in prolonged GI procedures such as endoscopic submucosal dissection (ESD) of GI neoplasms. The aim of this study was to assess the safety and efficacy of CO2 insufflation during ESD involving the upper and lower GI tract. Methods: Retrospective analysis of outcomes of CO2 versus room air insufflation in 115 patients undergoing upper and lower GI tract ESD procedures (36 patients in the CO2 group from 2/08-11/08 versus 79 patients in the room air insufflation group from 6/06-2/08). All ESDs were performed by a single experienced endoscopist (MRA). Both groups underwent the procedure supported by anesthesia and surgical backup (where applicable). Results: The locations of the lesions in the CO2 group consisted of 24 colonic, 7 rectal, 3 esophageal, 1 gastric, and 1 duodenal while the room air group consisted of 40 colonic, 16 rectal, 6 esophageal, and 17 duodenal. The mean size of GI lesions were similar between the two groups (3.65 versus 4.10 cm, p=0.18). The CO2 group demonstrated a statistically significant shorter procedure time (85.11 versus 106.67 minutes, p=0.03) as compared to the room air group. Also, the CO2 group showed a trend, although not statistically significant, toward a better en-bloc resection rate (94.4 versus 84.8%, p=0.07) and a reduction in perforation rate (2.8 versus 10.1%, p=0.09). No statistically significant difference was noted between the two groups for bleeding rates (2.8 versus 3.8%, p=0.39). The median length of hospital stay for the CO2 and room air group was one day each. Conclusion: CO2 insufflation may be a better alternative to room air insufflation in ESD due to the decrease in procedure times. Also, CO2 insufflation demonstrated a trend toward increased en-bloc removal of the lesions and decreased perforation rate. Further larger studies are needed to demonstrate the superiority of CO2 insufflation during ESD, especially for en-bloc resection and perforation rates.
W1055 Diagnostic Testing Complementary for Diagnosing Ileal Pouch Disorders Linda Y. Tang, Hui Cai, Bo Shen, Lauren Moore Background & Aim: Various imaging techniques have been used to assess ileal pouch disorders including CT enterography (CTE), gastrograffin enema (GGE), magnetic resonance imaging (MRI) and pouch endoscopy (PES). The purpose of this study is to evaluate the effectiveness of these imaging techniques as compared to the gold standard of the final diagnosis made by all the tests combined. Methods: 66 patients from the Pouchitis Clinic at the Cleveland Clinic who had a PES and at least one other imaging modality (CTE, GGE or MRI) were included in the study. We analyzed the accuracy of these tests to diagnose inlet strictures, outlet strictures, fistulas, sinus disease and cancer in our patient population. Results: In total, 66 patients underwent evaluation with PES (N=66), CTE (N=23), GGE (N=34) and MRI (N=26). The mean age was 41.5±14.5 years. There were 28 females (42.4%). 60 patients (90.9%) had J pouches and 59 patients (89.4%) had a preoperative diagnosis of ulcerative colitis (rather than indeterminate colitis). Conclusions: CTE had a lower accuracy in diagnosing inlet stricture than GGE, MRI or PES. MRI was less accurate in diagnosis of sinus disease. Overall, these modalities appear to be complementary and each has their strength in the diagnostic paradigm. Table 1. Correlation of PES with other Diagnostic Tests
W1058 Table 2: Accuracy of Diagnostic Tests
Patient Satisfaction and Endoscopic Visibility of Two Colonic Lavage Solutions: A Comparison Rogier J. De Ridder, Silvia Sanduleanu, Gwen Masclee, Yolande Keulemans, Wim Hameeteman, Ad Masclee Background : New endoscopic techniques have been introduced to further improve diagnostic accuracy of colonoscopy. In this respect optimal cleansing of the colon is crucial while patient burden of lavage should be minimal. Aim: To assess the efficacy and patient satisfaction of a new colon cleansing product polyethylene glycole (PEG 3350, 3 Litres, without sodium sulphate, Endofalk®) compared to the standard preparation (PEG 3350, containing sodium
AGA Abstracts
A-644