Abstracts

observation of ulcer base might be advantage for assessment of visible vessels afterprophylactic APC for visible vessels and the large size (O 1 cm) ofpolypectomy induced ulcer was associated with visible vessels in ulcer baseafter colonic EMR.

Tu1513What Is the Optimal Timing for Resumption ofAntithrombotic Therapy After Endoscopic Resectionof Colorectal Tumors?Kazuko Beppu*1,2, Naoto Sakamoto2, Taro Osada2, Kenshi Matsumoto2,Tomoyoshi Shibuya2, Akihito Nagahara2, Tatsuo Ogihara2,Sumio Watanabe21Gastroenterology, East Tokyo Metropolitan Hospital, Tokyo, Japan;2Gastroenterology, Juntendo University, Tokyo, JapanBackground and Aim: The use of anticoagulants and antiplatelet agents for variouscardiovascular diseases has become increasingly widespread. Before performingendoscopic procedures on patients taking these medications, endoscopists mustweigh the risk of thrombotic events caused by the cessation of antithrombotictherapy against the risk of post-operative hemorrhage. Medical society guidelinesrecommend that antithrombotic agents be restarted as soon as ‘bleeding stabilityallows’; however, there are only scanty data regarding the optimal timing and risk ofresumption of these medications. The aim of this study was to investigate when torestart antithrombotic agents after endoscopic resection. Method: 7359 cases ofpolyps removed by hot biopsy, polypectomy, endoscopic mucosal resection orendoscopic submucosal dissection between 2006 and 2013 were identified. We

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performed a case-control study, comparing cases with bleeding after endoscopictreatment, and non-bleeding cases which were selected at 1:3 ratio matched for ageand gender. We investigated patient-related factors (resuming anticoagulants and/orthienopyridines, a representative antiplatelet drug, within the 5 days followingendoscopic resection, aspirin use, hypertension, diabetes mellitus) and polyp-related factors (morphology, location, resection technique) by multivariate logisticregression analysis. We analyzed two groups, separated according to tumor size!10mm and R10 mm. We also examined the intervals between endoscopic treatmentand bleeding. Results: 82 bleeding cases (1.1%) were aged 61.9�11.6 years(mean�SD), and 82% were males. In the!10 mm group, the anticoagulantswarfarin, dabigatran and/or heparin were resumed within the 5 days followingendoscopic resection in 36% of bleeding cases compared to 5% of control cases (OR15.7; 95% CI 2.9-85.5; pZ0.002). Thienopyridines (OR 3.4; 95% CI 0.2-46.8;pZ0.36), aspirin with thienopyridines (OR 0.5; 95% CI 0.01-39.2; pZ0.78) were notfound to be significant risk factors for bleeding. In the R10 mm group, a significantand independent risk factor was resuming anticoagulants (OR 6.7; 95% CI 2.3-19.7;pZ0.0005). Thienopyridines (OR 2.5; 95% CI 0.5-13.7; pZ0.28), aspirin with thie-nopyridines (OR 0.1; 95% CI 0.007-1.6; pZ0.1) were not significant. The interval tobleeding was longer in cases with a combination of antithrombotic agent than inthose with a single or no antithrombotic agent (median 4 days, range1-12 days vs. 3days, 1-11 days, pZ0.03 by Mann-Whitney U test). Conclusions: Resuming antico-agulants within the 5 days after endoscopic resection was strongly associated withbleeding whereas resuming thienopyridines with or without aspirin within the 5days posed no risk regardless of tumor size. The interval between endoscopictreatment and bleeding can be as long as 12 days in cases with a combination ofantithrombotic agents.

Tu1514Treatments for Rectal Variceal Bleeding With Portal HypertensionTakahiro Sato*Gastroenterology, Sapporo Kosei Hospital, Sapporo, JapanBackground: Bleeding from ectopic varices, which is rare in patients with portal hy-pertension, is generally massive and life threatening. We evaluated treatments forrectal variceal bleeding. Methods: From January 1994 to October 2013, we per-formed endoscopic treatments or interventional radiologic treatments for 1700portal hypertensive patients with esophagogastric varices. In this study, we evalu-ated the clinicopathological features and treatments of 36 rectal variceal bleedingpatients. Thirty-six patients were hospitalized for gastrointestinal bleeding fromrectal varices. The underlying pathologies of portal hypertension included livercirrhosis in 21 patients, cirrhosis associated with hepatocellular carcinoma in 5,primary biliary cirrhosis in 3, idiopathic portal hypertension in 4, extrahepatic portalvein obstruction in 2 and the other disease in 1. Results: Thirty-five of 36 patientswith portal hypertension had previously received emergency or prophylacticendoscopic injection sclerotherapy (EIS) for esophageal varices. In 26 of the 36rectal variceal patients, EIS was successfully performed with no complications. In 6patients, endoscopic band ligation (EBL) was performed, and 5 of whom experi-enced no operative complications after EBL. Colonoscopy revealed bleeding fromulcers after EBL in 1, and endoscopic clipping was successfully performed on theoozing ulcers. Combination therapy EIS plus EBL was successfully performed on 2patients. Percutaneous transhepatic obliteration (PTO) was performed for the re-maining 2 large rectal variceal patients with no complications. Endoscopic hemo-stasis of rectal varices was successful in 34/34 (100%), PTO in 2/2 (100%),respectively. Conclusion: Hemorrhage from ectopic varices should be kept in mindin patients with portal hypertension presenting with lower gastrointestinal bleeding.Endoscopic treatments or interventional radiologic treatments were useful for rectalvariceal bleeding.

Tu1515Endoscopic Management of Moderate or Severe LowerGastrointestinal BleedingCarolina V. Teixeira*, Marcelo Averbach, Paulo a. Correa, Rodrigo R. Zago,Giulio F. Rossini, Pedro Popoutchi, Jarbas Loureiro, Jose Luiz PaccosEndoscopy, Sírio-Libanês Hospital, Sao Paulo, BrazilAcute lower gastrointestinal bleeding (ALGIB) can be defined as any gastroin-testinal bleeding of recent onset (within the last 12 - 24hours) originatedbeyond the ileocecal valve. The incidence of ALGIB is estimated on 20 casesper 100,000 adults, which represents one quarter to one third of patientshospitalized for gastrointestinal bleeding. A total of 38.686 colonoscopies wereperformed from January 1985 to December 2012 at Sírio-Libanês Hospital, SaoPaulo, Brazil. Two hundred thirty-four patients (0.6%) had ALGIB of moderateor severe intensity. In these 234 patients, a definitive diagnosis was possible in151 cases (64.5%). We defined the patients with ALGIB of moderate or severeintensity as lower gastrointestinal bleeding of recent onset (!6 hours) andhematocrit!28% or need of blood transfusion. For such patients, their medicalcharts and colonoscopy results were retrospectively reviewed for the currentanalysis. The study protocol was approved by the Institutional Review Board ofHospital Sírio-Libanês, and written informed consent was absent due to theretrospective nature of the study. After clinical stabilization and an uppergastrointestinal endoscopy without signs of bleeding, the patients underwent an

ume 79, No. 5S : 2014 GASTROINTESTINAL ENDOSCOPY AB461

Abstracts

anterograde preparation of the colon with manitol solution, 750 to 1500ml, in aperiod of 1 to 2 hours. All examinations were done under sedation. All thecolonoscopies were performed by the same medical team and with an Olympus(Olympus Optical Co, Ltd, Tokyo, Japan) or Fujinon (Fujifilm Corporation, To-kyo, Japan) colonoscope. The predominant sources of bleeding were colonicdiverticula (73 patients; 31%) and ischemic or infectious colitis (18 patients;7.7%). A specific therapeutic intervention was done in 61 patients of 151 pa-tients who had the diagnosis confirmed (40.4%), according to the underlyingsource of bleeding. Most patients with postpolypectomy bleeding were treatedwith injection of epinephrine (40%) and clip (40%). Patients with angiodysplasiawere treated predominantly with argon plasma coagulation (42%). Injection ofepinephrine was the most frequently used treatment, regardless of the sourceof bleeding (34.4%) followed by argon plasma coagulation (31.1%). Control ofactive hemorrhage was achieved endoscopically in 98.8 % of the patients whounderwent a therapeutic method. Only one patient with ALGIB secondary tocolonic diverticula did not have success with endoscopic treatment (epineph-rine injection) and was referred to surgery. Our data shows that early colo-noscopy in the management of patients with suspected ALGIB is an useful toolfor diagnosis and treatment. Colonoscopy thus seems to be one of the besttherapeutic modalities in ALGIB.

Main source of bleeding found at colonoscopy

CONDITION

AB462 GASTROINT

NUMBEROF

CASES

ESTINAL

PERCENTAGE

ENDOSCOPY

NUMBEROF

DIAGNOSIS

Volume 79

NUMBER OFPATIENTSTREATED

COLONICDIVERTICULA

73

31% 24 10

ISCHEMIC andINFECTIOUS COLITIS

18

7.7% 18 0

RADIATION COLITIS

18 7.7% 18 15 NEOPLASMS andPOLYPS

16

6.8% 15 2

POSTPOLIPECTOMY

16 6.8% 16 8 UNDETERMINED 16 6.8% 0 0 BLEEDING AFTERPROSTATE BIOPSY

15

6.4% 15 6

BLEEDING PROXIMALTO THE CECALVALVE

15

6.4% 0 0

ANASTOMOTICBLEEDING -SURGICAL SUTURES

14

6.3% 13 6

ANGIODYSPLASIA

12 5.1% 12 7 RECTAL ULCER 6 2.7% 6 1 INFLAMATORY BOWELDISEASE

5

2.1% 5 0

OTHERS

4 1.7% 3 2 VISIBLE VESSEL 4 1.7% 4 3 CECAL ULCER 1 0.4% 1 0 RECTAL VARICES 1 0.4% 1 1 TOTAL 234 100% 151 61

, No. 5S : 2014

Tu1516Comparison of Microwave Coagulation With Monopolar andBipolar Coagulation in a Porcine ModelZacharias P. Tsiamoulos*1, Christopher P. Hancock2, Adelnesto Polecina1,Paul D. Sibbons3, Brian P. Saunders11Wolfson Unit for Endoscopy, St Mark, London, United Kingdom;2Department of Physics, University of Bangor, Gwynedd, UnitedKingdom; 3Department of Surgical Science, Northwick Park Institute forMedical Research, London, United KingdomIntroduction: Intra-procedural bleeding is considered an immediate serious adverseevent and a major concern for the endoscopists. Current endoscopic devices utilisemono-polar or bipolar energy to treat acute bleeding vessels or/and pre-coagulatevisible vessels. Methods: The optimal time range of application for the microwavemodality of a new endoscopic device "Speedboat-RS2 (S-RS2), Creo Medical Ltd, UK"was initial assessed compared to a standard mono-polar endoscopic device, Coa-grasper (CG), Olympus, USA. After histological assessment of the optimal timerange, a comparison of the S-RS2 to a standard bipolar endoscopic device, GoldProbe (GP), Boston Scientific, USA, and to standard monopolar CG was performedto assess the safety profile of coagulation with histology and the endoscopic per-formance of pre-coagulation in the porcine colon. The S-RS2 blade delivers micro-wave coagulation (5.8GHz) for hemostasis, and also has an insulated hull to preventthermal injury to the underlying muscle layer. Cold snare polypectomy (9mm) wasperformed to reveal the submucosal layer and video recorded on 3 consecutive 60kgpigs. The colonic resection sites were aligned in cranial-caudal direction. Thefollowing parameters were measured: histological assessment and pre-coagulationendoscopic performance. All animals were recovered for 2days, 5days and 7days.Results: In animal one, three microwave applications of duration of 5sec/10sec/15secwere applied to the revealed submucosa compared to standard CG of duration of1sec. Histology showed that 5sec and 10sec of microwave have equivalent histo-logical appearance with CG preserving the serosal integrity with mild muscle alter-ation. In animal 2/3, microwave was applied for 9 sec in 6 lesions, CG was applied for1-2sec in 6 lesions and gold probe was applied for 3-4sec in 6 more lesions. His-tology showed viable serosa with no muscle alterations in microwave S-RS2, viableserosa with mild muscle alterations in GP and viable serosa with mild/moderatemuscle alterations. In all cases muscle layer cells were contiguous. During the pre-coagulations endoscopic assessment, all modalities were applied to coagulatevessels with median calibre of 2mm before and after dissection. Effective pre-coag-ulation was achieved in 3 out of the 6 visible vessels (microwave) and in 2 out of the6 visible vessels (CG - GP). Effective coagulation (blood flow stopped) was similarafter the dissection, in all three groups. Conclusions: Compared to CG (monopolar)and GP (bipolar), the microwave modality of S-RS2 appears to be equivalent duringthe pre-coagulation phase. The safety profile of coagulation phase resembles theprofile of the other two modalities but with less muscle alterations in the histologicalspecimens.

Tu1517Rectal Bleeding: Should Colonoscopy Be Done in PatientsYounger Than 50?Dante Manazzoni*1, Juan E. Pizzala1, Victor H. Abecia1, Santiago Rinaudo1,Sebastian Duran1, Germá N. Ortmann1, Maria L. Martinez Posadas2,Carlos a. MacíAs Gomez1, Juan a. De Paula11Gastroenterology, Hospital Italiano de Buenos Aires, Buenos Aires,Argentina; 2Research and Investigation, Hospital Italiano de BuenosAires, Buenos Aires, ArgentinaIntroduction: The optimal strategy for evaluating young patients with rectal bleedingis still not clear. Guidelines and practices differ regarding evaluation of these pa-tients. The purpose of this study was to assess the prevalence and site of clinicallysignificant lesions in patients younger than 50 with rectal bleeding and, therefore,determine whether full colonoscopy would be necessary in these patients. Methods:We performed a cross sectional study of subjects between 18 and 49 years under-going outpatient full colonoscopy for rectal bleeding at tertiary medical center inBuenos Aires, Argentina, between January 2006 and June 2013. Patient’s data werecollected from electronic medical records. Rectal bleeding was defined as bright redblood from the rectum; red blood noted either in the feces, on toilet paper, or in thetoilet bowl. Lesions were characterized as proximal or distal to the splenic flexure.Patients were excluded if they had: positive personal history of colorectal carcinoma(CRC) or inflammatory bowel disease (IBD), positive first degree family history ofcolorectal neoplasms, presence of iron deficiency anemia, bleeding diathesis orbleeding requiring blood transfusion. Neoplastic polyps, CRC and IBD were definedas significant lesions. Results: We included a total of 592 patients (292 male) with amedian age of 40, intercuartile range (IQR) 20-49. The prevalence of significant le-sions were: CRC 2.4% (14), IBD 2% (12) and adenomatous polyps 16.6% (97) (43 ofwhich were advanced adenomas, with a global prevalence of 7.2%). The mostcommon finding was Hemorrhoids occurring in 53.4% of the patients (316) (Table1). CRC and adenomatous polyps were more frequently found distal to the splenicflexure; CRC 92.9% (13) vs. 7.1 % (1) (pZ0.04; OR, 5; 95%CI 1-32) and adenomatouspolyps 64.9% (63) vs. 35.1% (34) (pZ0.2; OR, 1.2; 95%CI 1-1.5). Advanced ade-nomas were also more prevalent distal to the splenic flexure; 79.1% (34) vs. 20.9%

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