Jong Won Byun

Usefulness of Forward-Viewing Endoscope for Endoscopic Retrograde Cholangiopancreatography in Patients with Billroth II Gastrectomy

Background/Aims Patients undergoing Billroth II (B II) gastrectomy are at higher risk of perforation during endoscopic retrograde cholangiopancreatography (ERCP). We assessed the success rate and safety of forward-viewing endoscopic biliary intervention in patients with B II gastrectomy. Methods A total of 2,280 ERCP procedures were performed in our institution between October 2008 and June 2011. Of these, forward-viewing endoscopic biliary intervention was performed in 46 patients (38 men and 8 women with B II gastrectomy). Wire-guided selective cannulations of the common bile duct using a standard catheter and guide wire were performed in all patients. Results The success rate of afferent loop entrance was 42 out of 46 patients (91.3%) and of biliary cannulation after the approach of the papilla was 42 out of 42 patients (100%). No serious complications were encountered, except for one case of small perforation due to endoscopic sphincterotomy site injury. Conclusions When a biliary endoscopist has less experience and patient volume is low, ERCP with a forward-viewing endoscope is preferred because of its ease and safety in all patients with prior B II gastrectomies. Also, forward-viewing endoscope can be used to improve the success rate of biliary intervention in B II patients.

1038 Lesser Sensitivity and Positive Predictive Value of Fecal Immunochemical Test (FIT) in Right Advanced Colonic Neoplasia Than Left Lesions

Background: Screening for Barretts esophagus (BE) and esophageal adenocarcinoma (EAC) with an EGD remains controversial, especially with regards to its cost-effectiveness. Prior models have not considered the added benefits of identifying early gastric cancer (GCA) or esophageal squamous cell cancer (SCC). In addition, screening costs can be reduced by performing screening EGD at the same time as screening colonoscopy. Aim: To evaluate the cost effectiveness of screening the general population for UGI cancers (EAC, esophageal SCC, GCA) by performing an EGD at the time of screening colonoscopy. Methods: A Markov Model was created using a hypothetical cohort of 50 year old patients with no gastrointestinal symptoms who are already undergoing screening colonoscopy. The primary decision compared two strategies: adding and not adding a screening EGD. Options for surveillance for non-dysplastic BE (NDBE) and low grade dysplasia (LGD), non-compliance with surveillance, endoscopic eradication therapy (EET) for BE with high grade dysplasia (HGD) and mucosal EAC, and endoscopic misdiagnosis were included in the model. Transition rates and utility values were taken from the published literature and expert consensus. Costs were viewed from the perspective of a third party payor and were obtained from the Centers for Medicare and Medicaid Services. The time horizon was from age 50 to age 80 or death. The primary outcome was the incremental cost-effectiveness ratio (ICER). Results: Screening the general population at the age of 50 for UGI cancers with surveillance of NDBE and LGD required

M1039 Prevalence and Risk Factors of Colorectal Neoplasms According to Coronary Artery Obstructive Disease

113,500 per quality-adjusted life-year (QALY) compared to no screening or surveillance. A screening only strategy (no BE surveillance) was dominated by the screening and surveillance strategy. If all patients were compliant with surveillance guidelines and all patients with HGD and mucosal EAC underwent EET (base case: 55% compliant, 50% choose EET while remaining undergo surgery), the ICER for screening and surveillance decreased to

Portal hypertensive gastropathy: correlation with portal hypertension and prognosis in cirrhosis.

92,300 per QALY compared to no screening or surveillance. In one-way sensitivity analyses, the prevalence of EAC, esophageal SCC, or GCA would have to increase by a factor of 10.3, 28.7, or 5.8, respectively to generate an ICER of less than

Risk Factors of Rebleeding Following Endoscopic Therapy for Nonvariceal Upper Gastrointestinal Hemorrhage

50,000 per QALY. Conclusion: The ICE ratio for screening the general population for UGI cancers with endoscopy remains high, despite accounting for reduced endoscopy costs and the combined benefits of detecting early EAC, esophageal SCC, and GCA. However, the ICER compares favorably to commonly performed screening strategies for other cancers.

Endoscopic Submucosal Dissection Using Hook Knife for Gastric Neoplasms: Therapeutic Efficacy and Safety

Background and Aim: African Americans (AA) are at higher risk for colorectal cancers than general population and the neoplastic changes could be detected if followed properly. The aim of this study was to evaluate the incidence of colon cancer in patients who have previously undergone polypectomy. Method: In a retrospective study, 4793 documented symptomatic (GI bleeding, abdominal pain, weight loss) patients aged 40-90 years with no personal or family history of familial adenomatous polyposis and inflammatory bowel disease who underwent colonoscopy were identified from pathology, surgery and colonoscopy centers of Howard University Hospital over a period of 49 years (1959-2007). Demographic characteristics and histological findings were recorded. The frequency of pathological subtypes (tubular, villous, and tubular-villus and adenomatous polyps) of colorectal polyps was determined. Logistic regression was used to assess the independent risk factor of malignancy in patients with a prior diagnosis of adenoma. Results: Among 4793 patients with colon adenoma (without cancer) diagnosed from 1959-2007. There were 1619 (34%) patients with only right sided adenomas, 2951 (62%) were left sided and 220 (4%) were had adenoma on both sides of colon. Among the adenoma cases 52% (n=74) were 64 years or younger. Half (n=48) of the patients developed cancer before 1999. During the study period colon cancer occurred in 3% of cases previously diagnosed with adenoma. Adjusting for effect of sex and age, tubular adenoma (OR:2.5, 95%CI:1.6-4.1) and right colon location (OR:5.7,95% CI:3.9-8.5) were risk factor for neoplastic changes in cases with adenoma. The median (IQR) duration between diagnosis of adenoma and subsequent colon cancer was 9 (4-15) years. Conclusion: Despite adenoma diagnosis and removal, neoplastic changes is a fairly prevalent outcome in African-American with colorectal adenoma. High risk groups includes right sided and multiple adenoma. Compliance with full colonoscopy after polypectomy will reduce the risk of neoplastic progression in this group.