were non-neoplastic: 1 heterotopic gastric mucosa and 1 inflammatory fibroid polyp. Resection was considered potentially curative in 9 of 23 patients (39%).
Abstracts
M1306 Efficacy of Bowel Preparation in Capsule Endoscopy: A Prospective, Randomized, Single-Blinded Controlled Study Allan H. Andrews, John Napierkowski, Jason Lake, Corinne Maydonovitch, Roy K. Wong
M1308 Comparative Study of the Efficacy Between Argon Plasma Coagulation and Injection Sclerotherapy for Bleeding Peptic Ulcer Gwang Ho Baik, Bong J. Kim, Joon D. Kim, Ahn Y. Seo
Background: Capsule endoscopy (CE) is emerging as the diagnostic test of choice for obscure GI bleeding. However, at present there is no standardized regimen for bowel preparation prior to CE. Methods: The study is a prospective, randomized, single-blinded cross-over trial comparing CE image quality following a purgative bowel preparation (PBP) to image quality after a standard bowel preparation (SBP). To date 11 subjects have completed the study. Each subject performed two separate CE procedures, acting as his or her own control. Subjects were randomized to perform the initial CE either with SBP (clear liquid dinner and fasting overnight) or PBP (ingesting 2 L of a polyethylene glycol/electrolyte solution 12 hours before the test and 40 mg of liquid simethicone one hour prior to the test). Two weeks later, each subject performed another CE study using the alternate bowel preparation. The primary outcome was the quality of small bowel mucosal images. Small bowel video time was divided into four equal ‘quartiles.’ Two observers, both experienced endoscopists who were blinded to the type of bowel preparation used, independently graded each quartile on a 1-4 scale defined as 4 Z ‘‘excellent’’ (greater than 90% visibility), 3 Z ‘‘good’’ (81-90% visibility), 2 Z ‘‘fair’’ (70-80% visibility), and 1 Z ‘‘poor’’ (! 70% visibility). Overall image quality was calculated as the sum of the four quartiles. A secondary outcome was patient tolerance between the two bowel preparations. Results: The 11 subjects (64% male) had a mean (SD) age of 61 (15) years. The mean hemoglobin was 9.8 (1.5). Median overall CE image quality following PBP was significantly better than image quality following SBP (10 [6-14] vs. 7 [4-11], p Z 0.022). In 9 patients (82%) image quality with PBP was higher than with SBP. There was no significant difference in patient tolerance between the two bowel preparations (p Z 0.437). Conclusions: Bowel preparation with a polyethylene glycol/electrolyte solution and simethicone prior to capsule endoscopy improves image quality of small intestinal mucosa.
Background and Aims: Argon plasma coagulaton (APC) is a contact-free electrocoagulation that is easier to target and have a controllable depth of coagulation. But, its efficacy is suspected in active bleeding ulcer and large diameter exposed vessel. The aim of this study was to compare the efficacy of argon plasma coagulation with injection sclerotherapy(EIS) in bleeding peptic ulcer. Patients and Methods: We reviewed 142 patients who underwent emergency endoscopy due to peptic ulcer bleeding between January 2000 to July 2004 in our hospital. Patients with previous gastric surgery, malignant ulcers, and Dieulafoy ulcers were excluded. The primary outcome measures were initial hemostasis by single method (APC or EIS) only, or by combined method with other modalities (APC, EIS, hemoclp, band ligation), rebleeding rates and complications. The bleeding activity was classified according to the Forrest classification. Results: One hundred forty-two cases were analyzed, 42 in the argon plasma group and 100 in the EIS group. Patient’s demographics and ulcer characteristics were comparable between the two groups. Initial hemostasis rate by single method with APC is 88.1%(37/42) and EIS is 84.0%(84/100); (p=0.737). All those who failed hemostasis by APC achieved hemostasis by combined method. Three patients in EIS group failed to achieve hemostasis despite combined method with other modalities(two patients underwent emergency surgery and one patient died during waiting for surgery). The rebleeding rate was 2.4%(1/42), 15%(15/100), respectively (p=0.099). One patient with rebleeding in APC group were treated with repeated endoscopic hemostasis by APC and EIS. Of those patients with rebleeding in EIS groups, eleven patients were treated with repeated EIS, two patients were treated with surgery, two patients were treated with hemoclip. In Forrest Ia, four patients were treated with APC (4/42) and twenty five patients were treated with EIS(25/100) . Initial hemostasis rate by single method with APC is 50%(2/4) and with EIS is 68%(17/25) in Forrest Ia. There were no serious complications in APC group and five patients were showed post injection ischemic ulcer in EIS group. Conclusions: Argon plasma coagulation and injection sclerotherapy are equally effective in achieving hemostasis in bleeding peptic ulcers. Comibination therapy with APC and other modalities would be needed to achieve higher hemostasis rate in Forrest Ia.
M1307 Videocapsule Endoscopy Versus Colonoscopy for the Diagnosis of Postsurgical Recurrence in Crohn’s Disease (CD): A Pilot Study Vicente Pons, Pilar Nos, Guillermo Bastida, Lidia Argu ¨ello, Belen Beltra´n, Beatriz Martinez, Alberto Fernandez, Rafael Estevan, Virginia Pertejo, Teresa Sala Background: The recurrence of CD after surgery treatment is frequent and unpredictable. The place of videocapsule endoscopy (VCE) in patients with CD who require endoscopic follow-up after surgery is unknown. The aim of this study was to assess the safety and accuracy of VCE in these patients. This is the first study using VCE for evaluating the recurrence of CD after surgery. Patients and methods: Eleven CD patients (7 female, 4 male, mean age 38 years, R: 25-58) with ileocolonic ´s disease were prospectively enrolled in this study from anastomosis for Crohn October 2003 to October 2004. All patients were asymptomatic (CDAI!200) and without any prophylactic treatment. Subjects were studied with a colonoscopy that included neo-ileum evaluation and a VCE. Both techniques were analysed in a blinded manner. Studies were graded as grade 0-4 according to Rutgeerts score (Gut 1984). A score O=2 was considered morphologic recurrence. VCE was performed within 2 weeks of colonoscopy. The M2A(R) Patency Capsule was administrated 1 week before VCE to verify the absence of strictures in the gastrointestinal tract. Patient´s preferences about the two procedures were recorded. Results: The colonoscopy was performed in all patients but the neoileum could not be reached only in one of them. M2A(R) Patency Capsule was easily swallowed by all of the patients. Only one patient excreted the M2A(R) Patency Capsule partially disintegrated and refused the VCE. Recurrence was visualized in 1 of 10 patients with colonoscopy and VCE. Six additional recurrences were visualized only by VCE. Moreover proximal involvement (duodenal or jejunal disease) was detected in 6 patients using VCE. Therapeutic management was changed in 6 patients according to VCE information. VCE was preferred to colonoscopy by 100% of patients. Conclusions: Our preliminary results suggest that the VCE can be superior and better tolerated than colonoscopy in the evaluation of the recurrence of CD after surgery.
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M1309 Diagnosis and Outcome of Small Bowel Tumours Found By Capsule Endoscopy: A Three Centre Australian Experience Adam A. Bailey, Henry Debinski, Mark Appleyard, Matthew Remedios, Judy Hooper, Warwick Selby Capsule endoscopy (CE) allows simple non-invasive examination of the small intestine. This report examines diagnosis and outcome in a series of 26 patients with small bowel tumours detected by CE in three Australian Centres since its introduction. Twenty-seven tumours were identified in 26 patients from 416 CE studies (8F:18M). The mean age was 57 years (28–81). The mean duration of followup was 507 days (116-1044). Indications for CE were: obscure GI bleeding (21), suspected bowel tumour (3), abdominal pain (1) and diarrhoea (1). Most patients had no symptoms suggestive of small bowel obstruction and had undergone gastroscopy and colonoscopy prior to CE. Prior radiology, most of which was normal, had been performed in 23 of 26 patients (SB series 17, CT 16, both in 11) and enteroscopy in 7. Histology was available in 25 of the 26 patients. Tumours were resected in 23 patients (88%). One patient with presumed jejunal carcinoma declined surgery and is still undergoing regular transfusion. Eighteen tumours found at CE were malignant: 6 small bowel adenocarcinomas, 6 carcinoid tumours, (4 of these metastatic), 2 melanoma metastases, 2 GIST tumours, 1 colon carcinoma metastasis and 1 non-Hodgkin’s lymphoma. Of the 5 patients with primary adenocarcinoma only one is disease free at follow-up. Three patients with carcinoid tumours have not had a recurrence, one of whom is now 34 months post resection. Both patients who had GIST tumours resected are disease free to date. The patients with melanoma have not had recurrent anaemia following resection. Other lesions included 4 hamartomas, 1 cystic lymphangioma, 1 primary amyloid and 1 small bowel lipoma. In 2 patients the tumours seen at capsule endoscopy were non-neoplastic: 1 heterotopic gastric mucosa and 1 inflammatory fibroid polyp. Resection was considered potentially curative in 9 of 23 patients (39%). Small bowel tumours are a significant finding at CE and are often unsuspected, not being found by other methods. In many patients detection of a tumour alters management and improves outcome. Even in malignant lesions, treatment is potentially curable in the absence of metastatic disease.
Volume 61, No. 5 : 2005 GASTROINTESTINAL ENDOSCOPY AB159
