Abstracts

with these endoscopes seems to lead to a higher quality examination resulting indetection of more pathology.

Table 1.

Variable 140 scope 160 scope 180 scope

AB230 GASTROINTESTINAL EN

DOSCOPY V olume 69, No

Number of polyps (pZ0.013)

1.70 1.73 2.87 Number of adenomas (pZ0.005) 0.96 0.92 1.52 Exam time, minutes (p!0.001) 23.74 21.08 25.44 Cecal time, minutes (pZ0.001) 10.30 5.82 7.38

M1391

Novel Use of Simultaneous Dual Endoscopy to Reconstitute

Completely Obstructed Esophagi and ColonJohn Dever, Drew Schembre, John J. Brandabur, Richard A. KozarekBackground: Complete GI luminal obstruction often requires surgery, however wereport four cases of complete visceral obstruction managed with endoscopy.Methods: Case 1. A 50-year-old man who underwent laryngectomy and radiation forlaryngeal cancer developed complete proximal esophageal obstruction afterradiation therapy. Antegrade and retrograde endoscopy via a gastrostomy site wereperformed. A 22 gauge EUS aspiration needle was guided fluoroscopically topuncture esophageal scar tissue and to allow wire passage. After balloon dilation,a 1 cm diameter biliary Wallstent� was placed for 2 weeks followed by an 18 mm �6 cm Polyflex� removable stent. Case 2. A 71-year-old man who had radiation forhypopharyngeal cancer 6 months prior presented with aphagia and completeesophageal occlusion. Antegrade passage of a 22 gauge EUS needle and guide wirewith fluoroscopy was performed in tandem with retrograde endoscopy via a PEGtract. Dilation and deployment of an 8 mm � 8 cm self-expandable metal stent wasaccomplished followed by a 12 mm � 4 cm partially covered bronchial stent. Case3. A 74-year-old man who had cervical esophageal squamous cell carcinoma treatedby chemoradiation developed esophageal occlusion. Retrograde insertion of anendoscope through a gastrostomy site allowed puncture of a blind esophageallumen and passage of a guidwire. This was followed by antegrade balloon dilationand passage of a NG tube into the stomach. Case 4. A 36-year-old man had a colonicperforation and required a temporary colostomy. Take-down was complicated bya leak, and complete stenosis ensued. One year later, combined antegrade per-ostomy colonoscopy and proctoscopy was performed with puncture of thestenosed anastomosis by a 22 gauge EUS needle. Balloon dilation was undertakenand a 16 mm Polyflex� stent was deployed backwards to reduce migration risk.Results: All patients underwent successful initial recanalization. All patients requiredadditional balloon dilation. Three of 4 patients were able to resume regular diets.Patient 2 developed self-limited pneumomediastinum and C5-C6 osteomyelitisrequiring stent removal which led to restenosis. Conclusion: Gastrointestinalreconstitution in cases of complete luminal stenosis is risky yet can be successfullymanaged with rendezvous endoscopy and temporary stenting.

M1392

Polyp Miss Rates By Colonoscopy Compared with Colon

Resection SpecimensKangnyeong Lee, Hang Lak Lee, Jai Hoon Yoon, Seung Chul Cho, OhYoung Lee, Byung Chul Yoon, Ho Soon Choi, Joon Soo Hahm,Sunggon Shim, Narae HaBackground and Aims: Colonoscopy is useful for the detection and removal ofcolonic polyps but the problems in quality control of colonoscopy is rising as thenumber of colonoscopic examinations increases as a result of increased healthpromotion programs. Although many studies determined by tandem colonoscopyreported that the polyp miss rates by colonoscopy were approximately 25%, themiss rates are not clear since there is no gold standard to diagnose colonic polypscomparable to colonoscopy. we compared the number of polyps found bycolonoscopy directly with that of polyps present in surgically resected colon toinvestigate how frequently colonoscopy might miss polyps and which factors couldaffect the polyp miss rate by colonoscopy. Methods: We retrospectively analysed 38patients who underwent colon resection for colorectal cancer and had synchronouslesions in the resected portion. The miss rate was determined by comparing thenumber of polyps detected at colonoscopy with that of the polyps present in theresected colonic segment. A statistical analysis was made about the influences ofthe location, the pathologic type, or the size of missed polyps on the colonoscopicmiss rates. Results: The number of polyps found in resected colon specimen were93, 68 of which were detected at colonoscopy, so the overall miss rate bycolonoscopy was 26.9%. Of 25 polyps missed at colonoscopy, 1 were R 10 mm insize and 24 were ! 10 mm. 9 of 69 adenomatous polyps were missed bycolonoscopy, while colonoscopy missed 15 of 18 hyperplastic polyps. In thedescending, transverse, ascending and sigmoid colon the miss rates were 0%, 29%,17%, 22% respectively. Conclusively, !10 mm polyps, hyperplastic polyps, those inrectum and cecum were more frequently missed in our study. Conclusions:Colonoscopy is an effective method to diagnose and treat polyps but we should notmiss the significant miss rates of polyps by colonoscopy. Endoscopists should pay

. 5 : 2009

more attention to find synchronous lesions in patients with known colorectalcancers, and not only technical advances but also quality control of colonoscopy ishighly warranted not to miss these synchronous lesions.

M1393

Randomized Trial of Oval Cup Versus Alligator Jaw Biopsy

Forceps for Ultrathin Upper Gastrointestinal EndoscopyJustin Cheung, Karen J. Goodman, Robert J. Bailey, Safwat Girgis,Richard N. Fedorak, John Morse, Tomasz Z. Guzowski, Mario S. Millan,Sander Veldhuyzen Van ZantenBackground: Ultrathin transnasal endoscopy is an emerging tool for endoscopicevaluation of the upper gastrointestinal tract. The biopsy channel diameter (2 mm)is smaller with the ultrathin endoscope and therefore small caliber forceps must beused. It is unknown if small biopsy forceps type influences histologic interpretation.Methods: As part of a community health project focused on Helicobacter pyloririsks, residents (R 9 yrs) of Aklavik, a remote town in Canada’s NorthwestTerritories, were invited to undergo endoscopy in February 2008. An on-site unitwas assembled in the local health centre to perform upper gastrointestinalendoscopy with an ultrathin endoscope (4.9 mm diameter) with gastric biopsies (2antral, 1 incisura, 2 body) for histology. Participants were randomized to eitherstandard oval cup (OC) or alligator jaw (AJ) 5 mm cup biopsy forceps. A singlepathologist blinded to forceps type interpreted the specimens. Outcomes includedbiopsy size, biopsy quality (scale 1-3, 1 Z suboptimal, 3 Z excellent), and gastricpathology. Results: 191 participants were randomized (OC 105, AJ 86). The mean(� SD) age was 40 (�17) years. The mean biopsy sizes were similar between for OC(2.9 � 0.6 mm) and AJ (2.9 � 0.5 mm), (diff 0.03, 95% CI -0.12, 0.20). There was nodifference in the mean biopsy quality for OC (2.0 � 0.0) and AJ (2.0 � 0.0). Therewere small differences between OC and AJ in diagnoses of H. pylori (70% vs 64%,p Z 0.35), acute gastritis (67% vs 60%, p Z 0.45), chronic gastritis (72% vs 63%,p Z 0.16), atrophy (14% vs 15%, p Z 1.0), and intestinal metaplasia (8% vs 9%,p Z 0.80). Conclusions: For ultrathin upper gastrointestinal endoscopy, thereappear to be minimal differences in gastric mucosal biopsy size, quality, anddiagnostic yield comparing oval cup and alligator jaw forceps.

M1394

The New Endoscopic Preparation and Risk Factors of Residual

Food in Patients Who Have Undergone Disital Gastrectmy: Water

Cleaning MethodSung-Bum Cho, Sun Young Park, Kyoung-Won Yoon, Wan-Sik Lee,Young-Eun Joo, Hyeun-Soo Kim, Sung Kyu Choi, Jong-Sun RewBackground: Food residue is frequently observed in the gastric remnant afterpartial gastrectomy, making it difficult to disgnose metachronous lesion in theresidual stomach. The aims of study were to clarify the risk factors of food residueand to study about effectiveness of new methods of endoscopic preparation in thepatients with disital gastrectomy. Methods: The endoscopic and clinicopathologicfindings of 708 patients with distal gastrectomy for gastric cancer wereprospectively reviewed from January to September of 2008. The two groups (Watergroup: 40 cases, 24 hour NPO (nothing per oral) group: 20 cases) were randomlydevided to sixty patients with large amount of food residue. The degrees of foodresidue were estimated to undergone endoscopic examination after 1-2 week later.The routine endoscopic preparation (20 hour NPO) was used in 708 patents withdistal gastrectomy. The water group was used to new endoscopic preparation(water cleaning method) that was ingested to total 1 L of water (150-200 mL/10minutes) from 19.00 to 20.00 the day before examination concomitant with 20 hourNPO. The NPO group was used to prolong fasting for 24 hours. Results: Theincidence of large food residue was 15.7%, 5.8%, 7.5%, 2.8% at 3, 12, 24 and 36months after distal gastrectomy. The independent risk factors of food residue were3 month endoscopy (ORZ42.2, 95% C.I.Z17.2-103.3), diabetes mellitus (ORZ3.5,95% C.I.Z 1.6-7.8), body mass index below 19.5 (ORZ2.3, 95% C.I.Z1.3-.4.0),Laparoscopic surgery (ORZ1.9, 95% C.I.Z1.1-3.3) and Billoth I (ORZ2.2, 95%C.I.Z0.8-5.6). Successful preparations of two groups at follow up endoscopy werehigher the water group (70%) more than the 24 hour NPO group (40%) (PZ0.025). The compliance of water cleaning method was good except two patientsthat complained to epigastric discomfort. Conclusions: The water cleaning methodcan be recommended as a preparation for endoscopy in patients who haveundergone distial gastrectomy, especially in patients with additional risk factors.

M1395

Improving Patient Process and Cycle Time During Colonoscopy

with the Lean and Six Sigma MethodologyElisabeth Raymakers, Hubert Piessevaux, Benoı̂t Debande,Dominique Vandenbosch, Ines Perez Y Mira, Pierre H. DeprezBackground and Aims: Improving patient flow process and cycle times inendoscopy is challenging but essential to improve patient’s satisfaction, to reduce

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