S1406

Determination of Factors That Foil Successful Observation

of the Entire Small Intestine During Double Balloon EndoscopyAkihito Ehara, Keigo Mitsui, Shu Tanaka, Atsushi Tatsuguchi,Yukie Yamada, Tsuyoshi Kobayashi, Yoshihisa Sekita, Tsuguhiko Seo,Masaoki Yonezawa, Kazuhiro Nagata, Yoshiaki Shibata, Shunji Fujimori,Teruyuki Kishida, Katya Gudis, Choitsu SakamotoBackgrounds & aims: Double balloon endoscopy (DBE) is a valuable diagnostic andtherapeutic modality that can in theory allow observation and treatment of theentire gastrointestinal tract. In actual clinical practice, however, the endoscopistoften fails to gain complete access to the intestine, whether the approach is via theoral or anal route. This study isolates the main factors that prevent throughinsertion of the DBE scope, to thwart full examination of the intestine. We alsoevaluated whether video capsule endoscopy (VCE) can provide missing data incases where DBE fails to reach the entire small intestine. Patients & Methods: Weused DBE to examine 167 patients at Nippon Medical School hospital between June2003 and August 2006. Total enteroscopy was attempted in 85 cases throughexamination of the gastrointestinal tract via both the oral and anal routes. Fourcases were excluded for medical reasons and the remaining 81 cases were selectedfor this study. We evaluated whether gender, age, Body Mass Index (BMI),examination interval, past history of abdominal surgery, or endoscope model(EN-450P5 or EN-450T5) prevented full passage of the DBE scope. We alsoperformed complementary VCE in 41 of the 81 cases. Results: The entire smallintestine could be accessed by DBE in 65 of 81 cases (80.2%), and the diagnosis ratewas increased in the entire small intestine visualization cases compared to in othercases. Gender, age, BMI, and examination interval did not correlate with extent ofDBE scope penetration. Past history of abdominal surgery (p Z 0.0028), andendoscope model (EN-450T5) (p Z 0.0291) correlated with extent of DBE scopeaccess. Among 41 cases that underwent both DBE and VCE, observation of theentire small intestine by DBE was possible in 30 cases. In the remaining 11 cases,observation of the entire small intestine was achieved by VCE in 9 cases. Inaddition, in cases with past history of abdominal surgery, observation of the entiresmall intestine was possible by either DBE or VCE in 18 of 20 cases. Conclusions:The main factors preventing successful and through insertion of the scope duringDBE include past history of abdominal surgery and choice of endoscope model.Because diagnostic rate obviously increases with observation of the entire smallintestine, the EN-450P5 scope model is recommended as first-line DBE for deepand complete access to the intestine, as well as a guide for follow-up examinationwith the EN-450T5 therapeutic model. VCE can compensate for gaps in DBE datawhere DBE fails to reach the entire small intestine. In addition, for comprehensiveexamination and to avoid complications DBE should be paired with VCEexamination.

S1407

Capsule Endoscopy Transit Time and Outcome of Double

Balloon EnteroscopyChristina A. Tennyson, Blair S. LewisBackground: Lesions identified on capsule endoscopy (CE) may requireendoscopic therapy. The options to reach such lesions include push enteroscopyand double balloon enteroscopy (DBE), via the oral or anal route. Both the timefrom the pylorus to the lesion and the percentage of small bowel transit time(SBTT) on CE have been reported to determine the type of enteroscopy used. Westudied the relationship of CE time in patients referred for oral DBE. Methods: Aretrospective chart review was conducted in patients undergoing DBE at our centerfrom 5/2005 to 10/2006. Patients were excluded from analysis if a CE was notperformed,was incomplete,read as normal,or conducted more than 6 months prior.The amount of time following capsule passage from the pylorus to the suspectedlesion was recorded and divided by the total SBTT. In those with O1 CE finding,thelast lesion was measured. Results: 78 DBEs were performed on 68 patients (meanage 67.7 years, 50% female). The indications for DBE were obscure bleeding(n Z 60), suspected tumor/polyps (n Z 6), suspected enteropathy (n Z 1) andsuspected Crohn’s disease (n Z 1). 33 patients were included in the analysis.Lesions detected by CE were reached by oral DBE in 22/33 cases (66.7%). The rangewas 16-170 minutes past the pylorus,percentage SBTT 8-53%. In the 11/33 negative

DBEs,the CE lesion ranged from 32-180 minutes or percentage SBTT 11-67%. Themean time to a suspected lesion in the positive DBEs was 60.8 minutes vs. 93.4minutes for negative DBEs (p Z 0.057). The mean percentage of SBTT toa suspected lesion was 22% in the positive DBEs vs. 40% in the negative DBEs (p Z0.015). Conclusions: In our experience, CE transit time did not reliably predictpositive findings on DBE.

Abstracts

www.giejournal.org V

S1408

Clinical Course of Subepithelial Masses Incidentally Found

By Endoscopic ExaminationsJong-Soo Lee, Hee Jung Son, Yeoung Ho Kim, Dong Kyung Chang,Poong-Lyul Rhee, Jae J. Kim, Jong Chul RheeBackground/Aims: The subepithelial mass is protruded lesion within thegastrointestinal lumen that is covered by normal-appearing epithelium. The naturalhistory of subepithelial mass is not clearly elucidated and appropriated strategy fortreatment of subepithelial mass is still controversial. The purpose of this study is toclarify the frequency and the natural history of subepithelial masses. Methods: Weinvestigated 104, 159 medical records of upper gastrointestinal endoscopyunderwent at the center for health promotion of Samsung medical center from1996 to 2003. 795 patients (0.76%) were diagnosed with subepithelial masses. 287patients have been followed up by upper GI endoscopy for 55.8 months (range36-120 months). Results: Mean age of the patients was 52 years (range 22-80) andthe male to female ratio was 2.38 (202/85). The size of the lesions was 8.9 � 5.0mm. Of the 287 lesions, 225 lesions (78.3%) were unchanged and 46 lesions (16%)had decreased or disappeared, 16 lesions (5.5%) had increased in size (from10.5 � 6.5 mm to 19.1 � 8.9 mm) after mean interval 36.8 months. Surgicalresection was performed for 2 cases, and they were diagnosed as gastrointestinalstromal tumor (GIST) and schwannoma. Conclusions: The frequency ofsubepithelial tumor is 0.76% in our study and 16 patients (5.5%) showed increasedin size. Most cases of the subepithelial tumors are not candidate for invasiveapproach, only regular follow-up is recommended. Rapid growth of subepitheliallesion is supposed to be one of the remarkable sign that indicate malignant change.

olume 65, No. 5 : 2007 GASTROINTESTINAL ENDOSCOPY AB167