Abstracts

Tu1536The Yield of Colonic Biopsy in the Evaluation of ChronicUnexplained DiarrheaRobert M. Genta*1,2, Amnon Sonnenberg3,41Miraca Life Sciences Research Institute, Miraca Life Sciences, Irving, TX;2Pathology, Dalls VAMC - UTSW, Dallas, TX; 3Medicine -Gastroenterology, Portland VA Medical Center, Portland, OR;4Medicine - Gastroenterology, OHSU, Portland, ORBackground and Aims: In clinical practice, colonoscopy is widely used for theworkup of chronic unexplained diarrhea. The aim of the present study was todetermine the yield of colonic biopsy in such endeavor. Methods: In a comput-erized database of 130,204 patients evaluated for chronic diarrhea, wetested the influence of biopsy site, number of tissue fragments, patientsymptoms and indication on the outcome of histopathologic evaluation.Differences in the number of biopsy fragments among subjects with differentdiagnoses or symptoms were compared using t-tests. Varying frequenciesof categorical variables between case and control populations werecompared, calculating odds ratios and their 95% confidence intervalsadjusted for age and sex. Results: The study population comprised 69% womenand 31% men aged (mean � SD) 52.8 � 17.4 years. Endoscopists tooksignificantly more tissue samples from endoscopically visible lesions than randombiopsies from macroscopically normal appearing mucosa (9.8 � 6.3 vs. 7.2 � 4.6,p!0.0001). Similarly, histopathologic diagnoses were significantly more oftenassociated with specific biopsy sites when compared to normal appearing colonicmucosa (OR: 1.33, 95% CI: 1.29-1.37). In 19% of patients, the histopathology re-vealed various types of mucosal lesion, the most common ones being microscopiccolitis in 8.6%, ulcerative colitis in 2.2%, Crohn’s disease in 0.6%, active colitis in5.0%, diverticulitis in 0.1%, and colonic ischemia in 0.5% of patients. In 29% ofpatients, the colonoscopy also revealed the presence of colon polyps, includinghyperplastic polyps in 14%, serrated adenomas in 2%, tubular and villous adenomasin 18%, and carcinoma in 0.2%. A significantly smaller number of adenomatouspolyps were found in patients with microscopic colitis (OR: 0.35, 95% CI:0.33-0.38), inflammatory bowel disease (0.18, 0.15-0.21), or active colitis (0.63,0.58-0.68) than in patients without mucosal inflammation. Similar patterns alsoapplied to hyperplastic polyps and serrated adenomas. Conclusions:Colonoscopy is a successful tool in the workup of chronic diarrhea, yielding adefinitive diagnosis in almost one fifth of all patients. As an added benefit it con-tributes to cancer prevention through the incidental findings of colonic neoplasm,although the overall prevalence rate of such lesions seems diminished in mucosalinflammation.

Tu1537Colonoscopy Findings Following Acute DiverticulitisJoseph a. Cristiano*, Josh Wilson, Michael Williford, David P. Miller,Richard S. BloomfeldSection of Hospital Medicine, Wake Forest Baptist Health, WinstonSalem, NCIntroduction: Current practice guidelines from the American College of Gastroen-terology recommend colonoscopy following acute diverticulitis to exclude colonneoplasia. There are observational studies that both support and refute that acutediverticulitis is associated with increased incidence of colorectal cancer. Addi-tionally, there are limited studies that correlate CT findings during acutediverticulitis with subsequent incidence of colorectal cancer. Methods: We identi-fied patients at least 50 years of age that presented to Wake Forest BaptistHealth from 2000 to 2011 with acute diverticulitis by ICD-9 code (562.11). Werecorded the results of any abdominal CT performed during the acute diverticulitisepisode and any subsequent colonoscopy performed at our institution within 6months and associated histopathology. Results: 1052 patients were identified whopresented with acute diverticulitis. Of these, 126 patients had a colonoscopy at ourinstitution within 6 months. Among these 126 patients, 35 (27.8%) patients werefound to have polyps with 8 of these having advanced adenomas or cancer.Three patients had colon cancer and one had a sigmoid lesion with high-gradedysplasia. Among the 4 patients with colorectal cancer or high-grade dysplasia,CT was radiographically supportive of acute diverticulitis without mass lesion in3 of these patients. One patient had stranding and inflammation consistent withearly diverticulitis on CT. A second patient had evidence of acute diverticulitis ofthe descending colon without abscess, mass or perforation. A third had evidence ofperforated descending/sigmoid diverticulitis, but no masses, obstruction orabscess noted. The fourth patient had evidence of a pelvic mass along with colonicthickening and surrounding inflammation. Conclusion: In our case series, patientswho underwent colonoscopy following acute diverticulitis were found to have aclinically significant incidence of advanced adenomas and colorectal cancer thatwere not identified on CT scan at the time of diverticulitis. This supportscurrent guidelines recommending colonoscopy following an episode of acutediverticulitis.

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Tu1538Ischemic Colitis Represents a High Risk for Mortality in ElderlyPatientsJanina M. Von Rueden*, Andreas Probst, Helmut MessmannDepartment of Gastroenterology, Klinikum Augsburg, Augsburg,GermanyBackground and study aims: Ischemic colitis is the most common manifestation of areduction of the intestinal perfusion, which is mostly transient and resolves spon-taneously. About 90% of cases of ischemic colitis occur in patients older than 60years, but also younger individuals may be affected. The etiology is multifactorial andthe clinical presentation variable. Because the clinical symptoms are often mild theseriousness of the incidence may be underestimated. Here we present initial resultssuggesting an increased risk for mortality in elderly patients presenting withischemic colitis. Patients and methods: In a retrospective study which analyzed theendoscopic database of the Klinikum Augsburg , Germany of the period of 1stJanuary 2012 until 31 October 2013, 38 cases of "ischemic colitis" had been regis-tered with results of endoscopic examination, histopathological findings and age.The initial clinical symptoms and the further clinical course were retrieved from themedical reports. For the study the patients were grouped according to age below orover 70 years respectively. The mortality for both groups was determined. Results:The distribution between the sexes was balanced with 20 female versus 18 malepatients (53 vs. 47 %), of which 28 patients (74%) had been older than 70 years.Relating to the segmental pattern an accentuation in the left flexur and the recto-sigmoidal junction was observed. In 30 cases diagnosis was confirmed histologically.The majority of the patients suffered from abdominal pain and passage of bloodrespectively bloody diarrhea. They were treated according to standard practice,including antibiotic therapy, analgesia and platelet inhibition via Aspirin. In sevencases the patients had to undergo intensive care treatment because of septic orhemorrhagic shock. Most of the patients (76 %) recovered well, whereas 9 patients(24%) died in the course of hospitalization. Strikingly, 7 of these patients were olderthan 70 years, which means 25% of the patients older than 70 years. Conclusions:Although the statistical power of this study is not very strong, the results presentedsuggest that ischemic colitis should be taken more seriously as it may cause anincreased risk for morbidity and mortality particularly in elderly patients. Based onthese initial observations it appears advisable to broaden the study with respect topatient numbers and possibly further subgroup analysis.

Tu1539Evaluation of a Novel Approach to Early Stage ColorectalNeoplasms: Endoscopic Submucosal Dissection. a JapaneseNational Registry StudyYutaka Saito*1,15, Mitsuhiro Fujishiro2,15, Shinji Tanaka3,15, Hiroyasu Iishi4,15,Tomohiko Miyata5,15, Mitsuru Kaise6,15, Takuro Shimbo7, Hideki Ishikawa8,14

, Naomi Uemura9,14, Junji Yoshino10,14, Katsutoshi Obara11,14,Michio Kaminishi12,14, Hisao Tajiri13,141Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan;2Department of Endoscopy and Endoscopic Surgery, The University ofTokyo Hospital, Tokyo, Japan; 3Department of Endoscopy, HiroshimaUniversity Hospital, Hiroshima, Japan; 4Department of GastrointestinalOncology, Osaka Medical Center for Cancer and CardiovascularDiseases, Osaka, Japan; 5Division of Gastroenterology, Jichi MedicalUniversity, Tochigi, Japan; 6Department of Gastroenterology,Toranomon hospital, Tokyo, Japan; 7Department of Clinical Researchand Informatics, National Center for Global Health and Medicine,Tokyo, Japan; 8Department of Molecular-Targeting Cancer Prevention,Kyoto Prefectural University of Medicine, Kyoto, Japan;9Gastroenterology, National Center for Global Health and Medicine,Tokyo, Japan; 10Dept. of Internal Medicine, Fujita Health University,Nagoya, Japan; 11Department of Endoscopy, Fukushima MedicalUniversity Hospital, Fukushima, Japan; 12Director, Showa GeneralHospital, Tokyo, Japan; 13Department of Endoscopy, The Jikei UniversitySchool of Medicine, Tokyo, Japan; 14The Japan GastroenterologicalEndoscopy Society, Tokyo, Japan; 15JGES Colorectal ESD Study Group,Tokyo, JapanBackground & Aims: In the West, when endoscopic polypectomy or mucosal resec-tion is not possible for early stage colorectal neoplasms, surgery is the standard ofcare. Endoscopic submucosal dissection (ESD) can potentially fill this gap betweenpolypectomy and surgery, giving another endoscopic treatment option that preservesthe native anatomy. However, while high en bloc resection rates for colorectal ESDhave been reported, these earlier reports were limited to specialized institutions. Thisstudy is, therefore, aimed to elucidate the efficacy and safety of ESD for early stagecolorectal neoplasms from a nationwide registry throughout Japan not only in referralcenters. Methods: The Japan Gastroenterological Endoscopy Society (JGES)

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