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Cardiorespiratory complications during gastrointestinal endoscopy: prospective analysis of frequency and outcome

Cardiorespiratory complications during gastrointestinal endoscopy: prospective analysis of frequency and outcome

3894 Prospective study of the ability of endoscopic ultrasound to localize duodenal gastrinomas.

The role of EUS in localizing duodenal gastrinomas remains controversial because of lack of prospective assessments. To address this question we prospectively studied 40 consecutive patients with Zollinger-Ellison syndrome (ZES) admitted to the NIH prior to surgery. All patients had conventional imaging studies (CT, MRI, ultrasound, angiography), somatostatin receptor scintigraphy (SRS), EUS (Olympus UM 20), catheter US [UM3R] with endoscopy [side-viewing endoscope-(TJF)] (CUS.Endo), followed by a standardized laparotomy with a Kocher maneuver, intra-operative ultrasound and duodenotomy. Seven patients had MEN-1 and ZES and 33 had sporadic ZES. Prior to surgery, at least one nonEUS imaging study localized a possible duodenal gastrinoma in 19 patients (48%); conventional imaging only in 28%; SRS in 42%; EUS alone, 35%; CUS.Endo, 45%; and EUS or CUS.Endo, 52%. At exploration duodenal gastrinomas were found in 18 patients (45%). EUS, CUS.Endo, both (EUS and CUS.Endo), and any other imaging (other imaging) had sensitivities of 47%, 64%, 71% and 61% and specificities of 65%, 58%, 52% and 64%, respectively. In the 8 patients with all other imaging negative with a duodenal gastrinoma, EUS was positive in 50% (4/8), CUS.Endo in 38%, or either in 62%. In the 22 patients without a duodenal gastrinoma a false positive localization occurred with EUS in 5/22 (23%); CUS.Endo in 32%; both, 36%; and with other imaging in 36%. The sensitivity of SRS alone for localizing a duodenal tumor was 56%; SRS + EUS, 83%; SRS + CUS.Endo, 83%; and SRS + both, 88%. These results demonstrate that EUS alone will localize 47% of duodenal gastrinomas, which is slightly less than the 61% seen with a combination of other imaging studies. However, if combined with careful endoscopy using a side-viewing endoscope and catheter ultrasound, it will localize 71%. Both procedures are complementary to SRS, correctly localizing a duodenal gastrinoma in 88% of patients; however, the combination of both endoscopic procedures also increases the false positive rate and decreases the specificity.

3350 The complication rate of duodenal polypectomy.

Endoscopic polypectomy has generally been considered a safe procedure for gastric and colonic polyps. The risk of duodenal polypectomy has not been clearly established. Aim: To evaluate the complication rate subsequent to duodenal polypectomy in comparison to polypectomy of gastric or right colon polyps. Methods: Complications associated with duodenal, right colon or gastric polypectomy were identified by review of the CORI database, morbidity and mortality records, and chart review over the last three years. Right colonic polyps were classified as those identified in the cecum, ascending colon or hepatic flexure. Procedure reports were reviewed to identify polyps at least 10mm that were removed by polypectomy. Demographic data as well polyp characteristics (sessile vs pedunculated) were included in the analysis. Results: Overall, there were 250 right colonic polypectomies performed, 60 gastric polypectomies, and 26 duodenal polypectomies. Of these, 38 right colon polyps, 13 gastric polyps, and 15 duodenal polyps were 10mm or more in size. Complications associated with polypectomy performed in these polyps 10mm or greater in size are shown below. Patients undergoing duodenal polypectomy had a complication rate of 26% vs. 9.8% for gastric and right colon polypectomies combined (P=0.19; CI 0.83-8.7). One patient undergoing duodenal polypectomy had a perforation and underwent surgery. There was no procedure-related mortality. There was no difference in age or morphology of the polyps between groups. All complications occurred with removal of sessile polyps. Conclusion: In patients with polyps 10 mm or greater in size undergoing polypectomy at our institution, those that had duodenal polypectomy had a trend toward a higher complication rate than those having polypectomy in the right colon or stomach.

7143 Gastrointestinal manifestations in patients with classical and hypermobile ehlers-danlos syndrome.

Ehlers-Danlos syndrome (EDS) is a heterogeneous group of inheritable connective tissue disorders. Gastrointestinal (GI) manifestations including giant epiphrenic diverticula, mega-esophagus, GI bleeding and spontaneous bowel perforation have been reported without specification of EDS type. There has been minimal systematic evaluation of GI symptomatology in patients with EDS, and no evaluation of GI symptomatology specifically in the subgroup with classical or hypermobile EDS. Aim: To prospectively evaluate GI symptoms of patients with classical or hypermobile EDS referred to the GI service at the National Institute of Health (NIH). Methods: Overall, 23 patients with classical or hypermobile EDS from NIH EDS protocol were evaluated by the GI service between July 1998 and December 1999. Endoscopic evaluation was performed in consenting patients. Ten patients underwent EGD, 7 underwent colonoscopy, and 3 underwent catheter ultrasound (CUS) during endoscopy.Wall thickness of both bowel and descending aorta was assessed by CUS. GI symtomatology are as follows: (see table.)Results: Of patients undergoing EGD, 3 had a hiatal hernia (30%), 1 had antral erosions, and 2 had esophageal inflammation. On colonoscopy, 3 (43%) were reported to have a redundant colon, 1 had colonic inflammation, and 1 had submucosal vascular inflammation. Average wall thickness at CUS (total thickness/ muscularis propria in mm) was as follows: esophagus (2.9/2.2), gastric antrum (3.6), duodenum (2.1/1.1), descending colon (2.9/1.5), sigmoid (2.7/1.2), rectum (2.9/1.0). The average size of the descending aorta in the thorax at CUS was 18mm (largest one was 24 mm), and its average size in the abdomen was 12.8mm. Conclusion: Gastrointestinal symptoms are common in patients with classical or hypermobile EDS. The most common symptoms are probably related to GERD or IBS. Mucosal findings occur in this symptomatic population but are not frequent. Hiatal hernias, redundant colon, and thickening of the intestinal wall (especially the muscularis propria) may occur. This study is ongoing.

7178 Fna and mucosectomy in submucosal gi-lesions in adjunct to eus/cus.

EUS and catheter ultrasound (CUS) have been accurate in submucosal GIlesions. Fine needle aspiration (FNA) and endoscopic mucosal resection (EMR) have been reported to enhance the ability to correctly diagnose submucosal lesions. Aim: To characterize submucosal lesions of the upper GI tract diagnosed by EUS with either FNA or EMR. Methods: Patients referred for evaluation of submucosal lesions between January 1998 and November 1999 were retrospectively reviewed. All patients were evaluated with CUS and EUS (Radial, Linear array or both). The patients were analyzed in two groups. Group I consisted of 21 patients in whom FNA was performed. Group II consisted of 7 patients in whom EMR was performed. EMR was only performed in patients with lesions confined to the mucosa or submucosa. In one patient both FNA and EMR was performed. This patient was included in both groups. Results: Overall, 29 patients were included in this study. FNA was performed in 22 patients. The mean number of passes with the FNA needle was 3, and the range was 2-8. A diagnosis was rendered in 27% (6/22) of patients in whom FNA was performed. EMR was performed in 8 patients. A diagnosis was rendered in all 8 patients in whom EMR was performed (100%). Of all submucosal lesions evaluated 10% (3/29) were potentially malignant. All potentially malignant tumors were carcinoids. In the one case where both biopsy techniques were used, both the FNA sample and the EMR sample revealed carcinoid. No complications occurred. Specific diagnosis determined at FNA or EMR are below. Conclusions: 1- FNA was diagnostic in only 27 % of patients with submucosal lesions 2. EMR was accurate in obtaining the final diagnosis in all cases. 3. EMR was safely performed in lesions up to 26mm. 4. 10% of submucosal lesions were potentially malignant

6959 Eus/cus of rectal lesions: fna or emr?

EUS and catheter ultrasound (CUS) have been accurate in diagnosing and staging rectal and perirectal diseases. Fine needle aspiration (FNA) and endoscopic mucosal resection (EMR) have been recently introduced. The aim of this study was to assess the accuracy and limitations of FNA and EMR in assessing rectal and perirectal Diseases. Methods: Between January of 1998 and December of 1999, 23 patients were evaluated with EUS/CUS for rectal lesions. All patients were evaluated with CUS and standard EUS (Radial, Linear array or both). Results: A total of 23 patients (15 with mucosal and 8 with submucosal lesions) were identified. Table 1 and table 2 show the EUS/CUS results B= Benign; M=malignant; ND= non-diagnostic; EMR= Endoscopic mucosal resection; *= Nodular lesions: Tubular adenoma; hyperplastic polyp(2); inflammatory nodules; normal colonic mucosa. Patients were divided into 2 groups: Group 1 consisted of 15 patients with mucosal lesions. Group 2 consisted of 8 patients with SM lesions. The results of EUS/CUS were correlated with FNA and EMR if available. Conclusions: 1- FNA was accurate in assessing benign mucosal lesions. 2-FNA was accurate in diagnosing and staging malignancy in mucosal lesions. 3- EMR can be performed in limited mucosal and submucosal carcinoids. 4- EUS/CUS and FNA was as accurate as EMR. 5- Complications may occur in recto-vaginal cystic lesions.