Abstracts

Mo1492Making a Real Training Model for EUS-FNA WithSimple and Cheap Using Isolated Porcine Stomach:Its Feasibility and RepeatabilityKoki Hoshi*, Atsushi Irisawa, Goro Shibukawa, Yoko Abe, Akiko Saito,Koh Imbe, Akane YamabeGastroenterology, Fukushima Medical University Aizu Medical Center,Aizuwakamatsu city, JapanBackground and Aim: Animal models as virtual reality simulator are used fortraining of both basic and advanced endoscopic techniques. Several benchtraining models for EUS-FNA using agar gel with fruits and vegetables, andexcised porcine stomach with grapes have been used to practice the handlingof the endoscope and needle. However, procedures using these models aretoo easy and cannot replicate the feeling of resistance that is present in thetumor. In addition, using these models, it is not able to confirm to obtainadequate materials by pathological examination. Until now, usefulness of theEUS-FNA model using live animal has been reported. In fact, a live pig seemsto be the best model, as its anatomy is similar to that of a human. However,the live animal model is not easy to prepare and pretty expensive. The aim ofthis study is to develop the real EUS-FNA model for training without use of alive animal, and to assess its feasibility and repeatability. Materials and Methods:We created the EUS-FNA training model by using the isolated porcine stomach.Preparation; 1) the porcine stomach was reversed a mucosal side and serosaside, 2) several fresh chicken tenderloins (20-30mm in diameter) as a targetlesion for EUS-FNA were embedded in the submucosal layer with incision ofmucosa, 3) after suturing the incision, the stomach was re-reversed, 4) thestomach was fixed with nails to plate it, and placed in a tub that was filled withwater. Rapid on-site pathological evaluation (ROSE) was performed usingGimsa staining. Results: Feasibility; An EUS-endoscope (GF-UC240P, Olympusmedical systems, Japan) was inserted into the stomach through a cutting planeof esophagus, and the target lesion (chicken tenderloins) was clearly identified.EUS-FNA could perform using needle (EZ-shot 22G, Olympus medical systems,Japan) with feeling of resistance. In addition, rapid on-site pathological evalu-ation was easily done. Preparation time for this model was 30 minutes and totalcost was only $22. Repeatability: Three endoscopists (1 expert and 2 trainees)tried EUS-FNA using this model. Each endoscopist performed by 10 times.Adequate samples for histology/cytopathology were taken in 7 times of expert, 8times of trainee A, and 8 time of trainee B. The rate of adequate sampling wasapproximately 77%. Conclusion: An easy-to-use and inexpensive model for EUS-FNA with real feeling of resistance of needling was developed. One of the benefitsof this model was considered to confirm whether the adequate tissue was ob-tained or not. This model will allow the beginner to practice the safe and effectiveprocedure of EUS-FNA.

Mo1493Descriptive Study About Correlation of PancreaticCystic Lesions Findings by Confocal Microscopy and OtherDiagnostic ProceduresMonder Abusuboh Abadia*1, Miquel Masachs Peracaula1, Jordi Armengol1,Juan a. ColáN1, Joan Dot1, ANA Benages1, Maria D. Castillo1,Jose C. Salord1, Sergey Kantsevoy1, Joseph R. Armengol1, Natalia Tallada2,Carmela Iglesias21Digestive Endoscopy, Hospital Vall Hebron, Barcelona, Spain;2Pathology, Hospital Vall Hebron, Barcelona, SpainIntroduction: During the last years, endoscopic ultrasonography (EUS) has beenone of the most used techniques for the study of pancreatic cystic lesions.Despite the development of techniques, many of these lesions remain withoutdiagnosis. Recently, a new technique has been introduced through EUS,confocal laser microscopy (CLM). This technique allows real-time microscopicimages of these kind of lesions. Available information up to date is limited.Trials have focused on identifying structures to made diagnoses without Fineneedle aspiration (FNA) Objective: CLM may have similar findings and diag-nostic yield with that obtained by standard techniques. The objective is toevaluate the patterns recognized of CLM images and compare them with thediagnosis of pancreatic cystic lesions made by gold standard techniques.Materials and Methods: Descriptive, prospective and uncontrolled study on pa-tients admitted to our endoscopy unit for EUS-FNA of Pancreatic cyst. Imageswere obtained by EUS and CLM. Presumptive diagnosis obtained by pre-EUSimages (magnetic resonance, computed tomography), CLM, EUS and EUS-FNAwere compared. We have included 10 patients from March to September 2013.A linear Echoendoscope (Olympus UCT- 140 �), EchoTip probe 19G Cook �needles and AQ-Flex� 19 probe (Cellvizio, Mauna Kea Technologies) wereused for imaging after fluorescein injection. The images were interpreted byon-site pathologist Results: 10 patients were included (average age 73.3 years, 6women, 4 men). Average size of the lesions was 30.37 � 13.44 mm (Mean �

AB350 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 5S : 2014

SD) by pre-EUS images and 28 � 15.66 mm by EUS. About the location, 60 %were in the head, 30 % in the tail and 10% in the body of the pancreas.Previous diagnosis made by pre-EUS images were 30 % Cystadenoma, 30 %Intraductal papillary mucinous neoplasm, 20 % Simple cyst, leaving 20 % un-diagnosed. These findings were confirmed by EUS in 40 % of cases. Diagnosismade by EUS-FNA cytology has been 4 benign cysts, 2 Intraductal papillarymucinous neoplasm, 3 serous Cystadenomas and 1 Adenocarcinoma. Differentpatterns were identified by CLM, in 8/10 cases threadlike bright structures thatsuggest blood vessels, in 2/10 cases rounded structures appear to correlatewith normal acinar cells, in 1/10 case papillary proliferation, glands wereidentified in 2/10 cases and in 2/10 we identified fibrous tissue. No patient hasbeen involved in pancreatic surgical intervention. Conclusion: CLM allow theidentification of patterns that might suggest the diagnosis in real time, pro-posing in this way as a complementary technique to EUS and EUS-FNAcytology for the study of pancreatic cystic lesions. Technical difficulties areassociated with this technique. More information is needed in medical litera-ture about CLM findings in the study of pancreatic cyst.

Mo1494Evaluation of Pancreatic Cysts Without History ofPancreatitis in African Americans. Can Diabetes Mellitus BeConsidered As a Risk Factor?Anahita Shahnazi*2, Adeyinka O. Laiyemo2, Hassan Ashktorab2,Andrew Sanderson11Internal Medicine, Howard University College of Medicine, Washington,DC; 2Cancer Center, Howard University College of Medicine,Washington, DCBackground: Pancreatic cysts (PC) are collections of fluid adjacent to or within thepancreas. Alcohol consumption and gallstones are major risk factors for pancreatitis,which is itself a risk factor for pseudocysts formation. In patients without a history ofpancreatitis, however, the risk factors for PC have not been evaluated very well ingeneral and in African Americans (AA) in specific. Aim: The aim of this study is toevaluate PC risk factors in patients without history of Pancreatits in AA patients.Methods: We reviewed 207 patients’ medical records retrospectively from Jan 1988to July 2013, diagnosed with pancreatic cysts by the attending gastroenterologistbased on radiologic, clinical, laboratory, and pathology data. Statistical analysis wasdone by SPSS 21 and Chi-square tests. Results: Patients in this study were evaluatedin two groups: PC patients with and without documented history of pancreatitis. Themean age for the 207 patients was 50.4 years old (range 15-77). The mean age ofpatients without history of pancreatitis was higher (54 vs. 49). PC without history ofpancreatitis was detected more among female patients. 20% of patients’ BMI wasO30 and 72.9% of patients were overweight and obese(BMIO25). Smoking andalcoholism among patients with and without pancreatitis was 64% vs. 67% and 53%vs. 63%, respectively. The rate of PC without history of pancreatitis has beenincreasing in a stepwise fashion in the last 25 years based on five year interval (from41% to 49%) and the same time diabetes mellitus (DM) significantly increased from8.3% to 52.7% . 29% of patients without history of pancreatitis were diabetic vs 11%of patients with history of pancreatitis, PZ0.001. Conclusion: Our results demon-strate that the diagnosis of Pancreatic Cyst(s) is increasing and Diabetes Mellitus maybe an underlying risk factor for AA patients without prior history of pancreatitis.

Mo1495Dual Red Imaging; a New Endoscopic ImagingTechnology for Clear Visualization of Thick Blood Vessels inDeeper Tissue and Bleeding PointsJoichiro Horii*, Toshio Uraoka, Osamu Goto, A.I. Fujimoto,Yasutoshi Ochiai, Koji Takahashi, Naohisa YahagiDivision of Research and Development for Minimally InvasiveTreatment, Cancer Center, Keio University School of Medicine, Tokyo,JapanBackground: Dual Red Imaging has the potential to drastically improve the visu-alization of not only thick blood vessels in deeper tissue but also bleedingpoints by use of two wavelength lights in the red band. Contrast enhancementof thick blood vessels and bleeding points would be very useful for thereduction of bleeding risk and average time required for hemostasis e.g. duringendoscopic submucosal dissection. Very few imaging techniques like Dual RedImaging have been reported previously. Aim: To assess the visibility of thickvessels in deeper tissue and the bleeding points between Dual Red Imaging andWhite Light Imaging (WLI). Methods: Five endoscopists were enrolled to assessthe visualization of thick blood vessels and bleeding points. Study1; The visu-alization of thick blood vessels were assessed by using 137 Dual Red Imagingimages and 137 WLI images. The scores (1-3 scale) for the visibility of thickvessels were measured for all images (score 1; not visible, score 2; visible but

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