Preprocedure Diagnosis Research Articles

Outcome of Early and Late Onset Fontan Operation in Patients with Univentricular Heart Repair

Objective: To determine the outcome of early and late-onset Fontan operation in patients with univentricular heart repair. Study Design: Quasi-experimental study. Place and Duration of the Study: Department of Paediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi Pakistan, from Jan 2019 to Dec 2021. Methodology: During the study period, 121 patients of both genders, up to any age, with functionally univentricular hearts and who planned to undergo Fontan procedures were included. All cases were divided into two groups, Group-A had patients who underwent extra-cardiac Fontan at age ≤6 years, while Group B had patients who underwent extra-cardiac Fontan at age >6 years. Pre-procedure diagnosis, demographic, anatomic and hemodynamic characteristics, post-Fontan procedure morbidity and mortality were noted. Results: As per inclusion/exclusion criteria, 121 cases underwent Fontan surgery during the study period. There were 61(50.4%) male patients. Overall, the mean age was 7.02±4.6 years. Seventy-six 76(61.2%) cases were in Group-A and 45(38.8%) in Group-B. Mortality (within 30 days post-surgery) was reported in 11(9.1%) patients. Except for the mean duration of chest tube drainage ((0.010), there was no difference in terms of post-Fontan surgery outcomes between both study groups (p>0.05). Conclusion: The age of the patients at the time of the Fontan procedure did not affect the outcomes.

Electrocardiographic imaging to guide ablation of ventricular arrhythmias shows a higher benefit in patients with low intraprocedural burden

Abstract Background and aims Electrocardiographic imaging (ECGI) provides a non-invasive activation map of focal ventricular arrhythmias that has shown good accuracy regardless of the type of cardiac source used. Pre-procedure diagnosis in cases that are expected to be difficult and management of infrequent or poorly tolerated or multiple arrhythmias are some situations that may benefit the most from having an ECGI performed before the procedure. This study aimed to assess the benefit of the ECGI in patients with low intraprocedural burden. Methods We performed 81 ECGI procedures in 64 consecutive patients referred for ablation of ventricular arrhythmias (VAs). Ablations were performed with remote magnetic navigation or manually. The localization of the VAs based on the ECGI and invasive electroanatomic mapping was performed using a segmental model of the ventricles. A perfect match (PM) was defined as a predicted location within the same anatomic segment, whereas a near match (NM) was defined as a predicted location within the same segment or a contiguous one. The agreement between the ECGI and the invasive map was evaluated. The benefit of the ECGI in the subgroup of patients with intraprocedural infrequent VAs, defined as less than 1 VA complex /min, was assessed in terms of the success of the procedure. Results The ECGI was performed with the AMYCARD 01 only, in 26 patients, with the VIVO only, in 21 patients, and with both systems in 17 patients. Fifty-one patients underwent ablation. 65 ECGI procedures were performed before ablation in those 51 patients, 37 with Amycard with a rate of PM of 79% and NM of 97%, and 28 ECGI procedures with VIVO with 82% of PM and 93% of NM, not significantly different, respectively, p=0.764 and 0.573. The overall success rate was 80%. The low intraprocedural burden group included 28 patients (2 examples shown in the figure). The success rate was 86%, higher than the overall success rate, and much higher than the previously reported in the literature for this group of patients. Conclusions The ECGI was useful in predicting the location of the VA in general but was especially helpful in cases that are usually challenging, like patients with intraprocedural infrequent VAs.

How Long Should We Keep Children’s Surgical Sites Dry? The Incidence of Infection and Dehiscence After Pediatric Office Procedures

Objective: Studies evaluating the relationship between bathing and adverse surgical site events are sparse. In this study, we examine the incidence of surgical site infection (SSI) and dehiscence in a cohort of pediatric patients who were allowed to bathe 24 hours after their office procedures. Methods: Pediatric patients who underwent office procedures by a single plastic surgeon from 2017 to 2021 were included. All patients were allowed to bathe 24 hours after their office-based skin procedure. Age, sex, procedure type, pre procedure diagnosis, relevant past medical history, instances of dehiscence, and SSI were recorded. Results: 738 pediatric patients were included. Median age was 3.3 years(range 2 months-7 years), 46% were male and 54% were female. The most common pre procedure diagnoses were branchial vestige (24%), melanocytic nevi (21%), polydactyly (15%), congenital non-neoplastic nevus (11%), cyst (9%), hypertrophic scar (8%), and hemangioma(5%). No patients received systemic antibiotics post-procedurally. Six instances of dehiscence were recorded, and no SSIs were seen in any of the 738 patients. Conclusions: The low dehiscence rate and lack of SSIs in our cohort supports the hypothesis that children can bathe normally 24 hours after office procedures without adverse consequences. This recommendation can reduce the burden of post procedure wound care by reducing the length of time patients have to modify their bathing routines.

Retrospective analysis of stillbirth and induced termination of pregnancies: Factors affecting determination

ObjectiveThe aim of this study was to identify the factors and frequencies of induced termination of pregnancies. Materials and methodsThis is a retrospective study of 488 terminations of pregnancies (TOPs) between January 2011 and December 2021 to demonstrate the factors affecting the decision to terminate the pregnancy. All cases had been hospitalized to manage the induction of labor. Methods included serial multiple laminaria dilation of the cervix and administration of a cervical misoprostol suppository. After induction of labor, the subject may experience amniotomy, instrumental evacuation of the uterus, and even hysterotomy. Pre-procedure counseling included an agreement to share medical records (paper-based and electronic). We verified the indications for all patients seeking TOPs. All cases were performed according to known diagnostic classifications and divided into seven groups for analysis. ResultsThe patient ages ranged from 12 to 46 years. The median maternal age was 34 years [interquartile range (IQR) 30, 37]; 52.2% had at least one prior delivery. The pre-procedure diagnosis was divided into seven groups including the following: chromosomal and genetic abnormalities (146/488, 29.9%), no intrauterine heartbeats (126/488, 25.8%), structural anomalies (84/488, 17.2%), elective termination (56/488, 11.5%), preterm premature rupture of membranes (PPROM) (42/488, 8.6%), cervical incompetence (32/488, 6.6%), and other conditions (2/488, 0.4%). After excluding elective terminations, the eleven-year rate of fetal death and stillbirth to births did not show significant changes from 2011 to 2021. ConclusionsKnowing the factors underlying the decision to induce intrauterine fetal death (IUFD) including reasons for objecting to pregnancy are important for obstetricians—they can offer better planning and medical counseling. It is important to educate all women about family planning to prevent large numbers of unwanted and unsafe pregnancy terminations.

PO-710-04 CONTEMPORARY PREVALENCE AND PREDICTORS OF INTACT PULMONARY VEIN ISOLATION IN PATIENTS UNDERGOING REPEAT ATRIAL FIBRILLATION ABLATION

Pulmonary vein isolation (PVI) is the primary goal of atrial fibrillation (AF) ablation. Prior studies have noted a 50-95% prevalence of pulmonary vein (PV) reconnection at the time of repeat ablation. However, the prevalence of PV reconnection with contemporary AF ablation techniques, including high frequency jet ventilation, is unknown. Furthermore, there is an incomplete understanding of predictors of intact PVI at the time of repeat ablation. To assess the prevalence of PV reconnection in a contemporary cohort utilizing jet ventilation, contact force catheters, and adenosine testing for dormant conduction, and identify patient characteristics and ablation techniques that predict PVI at time of repeat ablation. We reviewed 615 consecutive radiofrequency AF ablations from 2013-2019 at an academic medical center performed by a single operator. There were 121 unique patients who underwent a de novo AF ablation followed by a repeat AF ablation. We evaluated clinical and previous procedural characteristics to identify predictors of PVI at the time of repeat ablation, using logistic regression models. Of the 121 patients, 42.1% were female, average age was 64.5 years, and BMI 31. At the time of repeat ablation, 57% (n=69) had intact prior PVI. Baseline characteristics of patients with intact PVI and reconnected PVI were similar, including age (64 years and 65 years; p=0.75), left atrial diameter (4.13 cm and 4.39 cm; p=0.09), left ventricular ejection fraction (54.5 % and 55.4%; p = 0.38), and time to first atrial fibrillation recurrence (237 days v. 344 days, p=0.28). The only significant clinical predictor of intact PVI was the pre-procedure diagnosis of atypical atrial flutter (20.3 % v. 3.8%, p=0.02) (Figure 1). In multivariate analysis, prior mitral line ablation (OR 8.93, 95%CI [3.65, 21.87]: p <0.01) and first pass isolation of right pulmonary vein during the index AF ablation (OR 2.59, 95% CI [1.09, 6.12]: p = 0.03) strongly predicted intact PVI at the time of repeat AF ablation. With contemporary techniques, PVI reconnection is seen in 43% of patients at the time of repeat AF ablation. History of atypical flutter, prior mitral line ablation, and first pass isolation of the right PVs were significant predictors for intact PVI.

Outcome of intrapleural fibrinolytic therapy with streptokinase in loculated pleural effusion patients- An experience from zonal hospital of Eastern India

Background: Loculated pleural effusion is one of the most common clinical entities which are usually caused by empyema, tubercular pleural effusion, malignancy, and hemothorax. The role of Intra-pleural Fibrinolytic Therapy (IPFT) with various fibrinolytics has been studied, however its clinical, radiological and functional outcomes are not assessed completely. Objective: This is a pre and post intervention study conducted at tertiary care hospital to assess the role of IPFT with streptokinase in patients with loculated pleural effusion. Results: 102 patients underwent IPFT with streptokinase. Out of 102 patients, 84 patient were male and 18 were females. Main preprocedure diagnosis were tuberculosis (n=70), pneumonia (n=21) and malignancy (n=11). The patients were subdivided into three groups based on sonologically assessed amount of intrapleural fluid - Group 1 (200ml). During pre and post IPFT procedure the number of patients identified in group 1 were 30 and 80, group 2 were 40 and 22, group 3 were 32 and none respectively. The mean residual pleural fluid drained before and after IPFT were 190.80ml and 57.84ml (p value Conclusion: IPFT with streptokinase is a safe option in loculated pleural effusion with no major adverse effects. Keywords: Intrapleural Fibrinolytic Therapy, Loculated pleural effusion, Fibrinolytics.

Pathological assessment of endoscopic resections of the gastrointestinal tract: a comprehensive clinicopathologic review.

Endoscopic resection (ER) allows optimal staging with potential cure of early-stage luminal malignancies while maintaining organ preservation. ER and surgery are non-competing but complementary therapeutic options. In addition, histological examination of ER specimens can either confirm or refine the pre-procedure diagnosis. ER is used for the treatment of Barrett's related early carcinomas and dysplasias, early-esophageal squamous cell carcinomas and dysplasias, early gastric carcinomas and dysplasia, as well as low-risk submucosal invasive carcinomas (LR-SMIC) and, large laterally spreading adenomas of the colon. For invasive lesions, histological risk factors predict risk of lymph node metastasis and residual disease at the ER site. Important pathological risk factors predictive of lymph node metastasis are depth of tumor invasion, poor differentiation, and lymphovascular invasion. Complete resection with negative margins is critical to avoid local recurrences. For non-invasive lesions, complete resection is curative. Therefore, a systematic approach for handling and assessing ER specimens is recommended to evaluate all above key prognostic features appropriately. Correct handling starts with pinning the specimen before fixation, meticulous macroscopic assessment with orientation of appropriate margins, systematic sectioning, and microscopic assessment of the entire specimen. Microscopic examination should be thorough for accurate assessment of all pathological risk factors and margin assessment. Site-specific issues such as duplication of muscularis mucosa of the esophagus, challenges of assessing ampullectomy specimens and site-specific differences of staging of early carcinomas throughout the gastrointestinal tract (GI) tract should be given special consideration. Finally, a standard, comprehensive pathology report that allows optimal staging with potential cure of early-stage malignancies or better stratification and guidance for additional treatment should be provided.

46 Comparison of Endoscopic Ultrasound Fine-Needle Aspiration and Fine-Needle Biopsy for Solid Pancreatic Masses

INTRODUCTION: The superiority of endoscopic ultrasound (EUS) guided fine needle biopsy (FNB) over fine needle aspiration (FNA) in sampling pancreatic solid masses is still controversial. FNA samples are relatively small and sometimes required increased number of needle passes to obtain a sample with preserved architecture. METHODS: Medical records of 182 patients who underwent ultrasound guided EUS with FNA and/or FNB of pancreatic lesions from University Louisville Hospital were reviewed in this retrospective study. Only those patients who had pancreatic solid mass lesions as pre-procedure diagnosis were included. Size of the lesions were classified in three groups: 0–1 cm, &gt; 1 cm–2 cm, &gt;2 cm. Adequacy of samples were determined by a pathologist. Post-procedure readmissions and/or ER visits, up to one month after EUS, were obtained from University of Louisville medical records. Welch Two sample t-test analysis was performed to assess the relationship between the number of passes and the technique used for biopsy. A P-value &lt; 0.05 deemed statistically significant. RESULTS: 78 patients were included in analysis. The average age was 63 and males represented 59% of the total population. 64% of the lesions were localized on the head, 16% in the tail, 11% in the body, and 9% in the neck of the pancreas. Size of most of the lesions were &gt;2 cm (74%) and &gt;1 cm–2 cm (19%). The mean number passes was 4, SD = 2. Compared with FNA, FNB did not require significantly lower number of passes (3.58 vs 4.36, 95% CI: −0.49, 2.06; P = 0.216). FNA was performed in 41% of the cases. From all the specimens submitted to pathology, there were 0 unsatisfactory specimens in the FNB group, and 2 (7%) unsatisfactory specimens in the FNA group (P = 0.161). From suspected malignant lesions, FNA could detect 31% of malignant neoplasms, and FNB 41%. Six patients required ER visit/Hospital admission after the procedure, but only 3 patients were admvitted for problems related to the procedure (pancreatitis, intractable nausea and abdominal pain). CONCLUSION: There is no difference between the number of passes between EUS-FNA and EUS-FNB for pancreatic solid masses.

Prevention of medical malpractice and disputes through analysis of lawsuits related to coronary angiography and intervention.

Background/AimsPossible fatal complications arising from coronary angiography (CAG), percutaneous coronary intervention (PCI), and coronary artery disease itself, are likely to cause medical disputes. Presenting the current status and reasons for judgments given in lawsuits related to CAG/PCI, this study aimed to identify ways to prevent unnecessary disputes and medical malpractice suits related to CAG/PCI through lawsuit analysis.MethodsA total of 13 cases (20 judgments) found in the Supreme Court of Korea’s Written Judgment Management System from 1998 to 2017 were analyzed.ResultsCoronary artery injury was the most common causative complication that led to lawsuits (n = 6, 46%). Six cases (46%) were ruled in favor of the plaintiff for violation of duty of care (n = 4) and duty of explanation (n = 2), respectively. Cases that violated duty of care included two errors in intra-procedure device manipulation, one in pre-procedure diagnosis, and one in management of post-procedure complication. Lack of explanation regarding the risk of complications was pointed out in both cases that violated duty of explanation. The average awarded amount for the damages was 114,436,064 Korean won.ConclusionsPhysicians need not fear unfair judgments so long as they follow standard of care because the Court consistently looked at the probability, the foreseeability, and the evidence. Therefore, maintaining standard of care is important. Besides, specific, detailed, and comprehensible explanations, including the risk of complications in addition to the necessity of procedures, are important to ensure the patient clearly understands the possible risk of adverse outcomes.

Etiology and characteristics of large symptomatic pericardial effusion in a community hospital in the contemporary era

The etiology and laboratory characteristics of large symptomatic pericardial effusion (LSPE) in the Western world have evolved over the years, and vary between regions, community and tertiary hospitals. We reviewed data of 86 consecutive patients who underwent pericardiocentesis or pericardial window due to LSPE in a community hospital from 2001 to 2010. The characteristics of the PE including chemistry, hematology, bacteriology, serology and cytology have been analyzed. We correlated the etiologies of PE with age, gender and clinical presentation. The most frequent etiology of LSPE was idiopathic [36% (77% with a clinical diagnosis of pericarditis)], followed by malignancy (31.4%), ischemic heart disease (16.3%), renal failure (4.6%), trauma (4.6%) and autoimmune disease (4.6%). The average age of all the etiological groups excluding trauma was over 50 years. Laboratory tests did not modify the pre-procedure diagnosis in any of the patients. The most frequent presenting symptom was dyspnea (76.6%). Chest pain was mostly common in patients with idiopathic etiology (58.06%). The most frequent medical condition associated with LSPE was the use of anticoagulant or antiplatelet drugs (31.40%), especially aspirin, and in those, the PE tended to be bloody (73%, P = 0.11). Most of the effusions were exudates (70.9%). PE due to renal failure was the largest (1467 ± 1387 ml). The spectrum of etiologies of LSPE in a community hospital in the Western world in the contemporary era is continuously evolving. The most frequent etiology is now idiopathic, followed by malignancy. Routine laboratory testing still rarely modifies the pre-procedure diagnosis.

Deep Venous Thrombosis after Saphenous Endovenous Radiofrequency Ablation: Is it Predictable?

Endovenous radiofrequency ablation (RFA) is a safe and effective treatment for varicose veins caused by saphenous reflux. Deep venous thrombosis (DVT) is a known complication of this procedure. The purpose of this study is to describe the frequency of DVT after RFA and the associated predisposing factors. A retrospective analysis was performed using prospectively collected data from December 2008 to December 2011; a total of 277 consecutive office-based RFA procedures were performed at a single institution using the VNUS ClosureFast catheter (VNUS Medical Technologies, San Jose, CA). Duplex ultrasonography scans were completed 2 weeks postprocedure in all patients. Risk factors assessed for the development of DVT included: great versus small saphenous vein (SSV) treated, right versus left side treated, number of radiofrequency cycles used, hypercoagulable state, history of DVT, tobacco use, medications (i.e., oral contraceptives, aspirin, warfarin, and clopidogrel), and vein diameter at the junction of the superficial and deep systems. Seventy-two percent of the patients were women, 56% were treated on the right side, and 86% were performed on the great saphenous vein (GSV). The mean age was 54 ± 14 years (range: 23-88 years). Three percent of patients had a preprocedure diagnosis of hypercoagulable state, and 8% had a history of previous DVT. On postprocedural ultrasound, thrombus protrusion into the deep system without occlusion (endovenous heat-induced thrombosis) was present in 11 patients (4%). DVT, as defined by thrombus protrusion with complete occlusion of the femoral or popliteal vein, was identified in 2 patients (0.7%). Previous DVT was the only factor associated with postprocedural DVT (P = 0.018). Although not statistically significant, there was a trend toward a higher risk of DVT in SSV-treated patients. Factors associated with endovascular heat-induced thrombosis alone were male sex (P = 0.02), SSV treatment (P = 0.05), aspirin use (P = 0.008), and factor V Leiden deficiency (P = 0.01). The use of RFA to treat patients with symptoms caused by saphenous reflux involves a small but definite risk of DVT. This study shows that the risk of post-RFA DVT is greater in patients with previous DVT, with a trend toward an increased risk in patients having treatment of the SSV. Periprocedural anticoagulation may be considered in this subset to reduce the risk of DVT after RFA. Thrombus protrusion without DVT was found to be more likely in patients with hypercoagulability, male sex, SSV treatment, and aspirin use. Additional prospective studies are required to analyze these and other factors that may predict thrombotic events after endovenous RFA.

Evaluation of Repeat ERCP: Analysis of a Four-Year Experience

In this trial, a total of 1010 ERCP procedures performed in 410 patients at the endoscopy department of our hospital between 2006 and 2010, were retrospectively evaluated. The age, gender, complaints, pre-procedure diagnosis, the radiologic and clinical results, number of procedure repetitions and the final diagnosis were assessed. The local Ethics Committee approved this retrospective study protocol. All of the procedures were performed by the same team of endoscopists with compatible levels of ERCP experience (Mean 5 years). At our department, pethidine HCl (0.3-0.5 mg/kg), midazolam (0.03-0.07 mg/kg) and hyoscine-N-butylbromide (0.3-0.6 mg/kg) are used in the ERCP procedures for premedication and additionally, cefazolin 1 gram intravenous is routinely administered for prophyllaxis one hour before the examination. During the procedure, oxygen saturation and heart rate are monitored by pulse-oximeter. The patients were those admitted to our hospital or referred from other healthcare centers. Statistical assessment was performed by evaluating the first ERCP procedures and the repeat procedure records. Chi-square test was used to statistically analyze the results. The level of significance was set at p<0.05.

Impact of Probe-based Confocal Laser Endomicroscopy (p-CLE) on the Diagnosis and Management of Indeterminate Gastrointestinal Lesions

Purpose: p-CLE enables real-time microscopic evaluation of gastrointestinal lesions encountered during endoscopy. Our aim was to evaluate the impact of p-CLE on indeterminate gastrointestinal lesions detected at endoscopy. Methods: All patients undergoing endoscopy with p-CLE over an 18-month period were enrolled prospectively in a database. p-CLE was performed when the lesions were considered to be indeterminate (no definitive diagnosis) or to confirm the findings of prior work-up. The pre-procedure diagnosis, diagnosis by p-CLE, histopathology result and the final diagnosis were recorded. p-CLE was considered to have established an impact if the findings resulted in a new diagnosis or altered subsequent treatment. Results: 45 patients (mean age 63 years, SD = 13.7; male 62%) underwent endoscopy with concurrent p-CLE. While the pre and post p-CLE diagnosis remained unchanged in 34 (76%) patients, p-CLE impacted the management in 11 (24%) patients (Table 1). Of these 11 patients, 6 were suspected to have a neoplastic process by prior work-up (esophageal lesions = 3, gastric lesion = 1, biliary stricture = 1, colonic mass = 1) that was proven to be benign by p-CLE and this was subsequently confirmed by histology or long-term follow-up. Five patients with suspected benign diagnoses from prior work-up (gastric ulcer = 1, biliary stricture = 3, colonic mass = 1) were proven to have neoplastic changes on p-CLE that were subsequently confirmed by histology or surgery.Table 1: Impact of p-CLE on patients with indeterminate gastrointestinal lesionsConclusion: Although limited, preliminary data suggests that p-CLE impacts the management in 24% of patients with indeterminate gastrointestinal lesions that can be missed by endoscopic sampling or prior work-up.

PleurX drain use in the management of malignant ascites: safety, complications, long-term patency and factors predictive of success

The aim of this article was to assess the success, safety, complication profile and factors associated with long-term patency of tunnelled peritoneal drains (PleurX) in the treatment of refractory malignant ascites. Over a 4-year period, 28 consecutive patients (32 drain insertions) with refractory malignant ascites were treated with a PleurX drain. The study group comprised 7 males and 21 females (mean age, 61 years). A combination of fluoroscopic and ultrasound guidance was used to insert 4 drains; the remaining 28 drains were inserted under ultrasound guidance alone. Patient history, biochemical profiles, pathological and procedural records and clinical follow-up until death were reviewed. Statistical analysis included multivariate logistic regression analysis and Kaplan-Meier curves (p<0.05 was considered significant). There was a 100% technical success rate for the insertion of the drain; there were no procedure-related deaths and no major complications. Only minor complications were reported: three (10%) immediate; three (10%) early; and two (7%) late. Factors significantly associated with these complications included current chemotherapy, low haemoglobin levels, low albumin levels, high white cell count and high c-reactive protein levels. The length of time the drains remained in situ, and therefore patent, ranged from 5 to 365 days (mean, 113 days). Out of the original 28 tunnelled drains, 24 (86%) remained in situ and functioning until the patients' death. Four (14%) drains dislodged and a subsequent PleurX drain was inserted on the opposite side of the abdominal wall. These new drains remained patent until the patient's death. The annual event rate was 0.45 events per year. A comorbid diagnosis of renal disease or chemotherapy was significantly related to a decreased length of patency. The use of tunnelled peritoneal drains is safe and effective and we would advocate their use as a first-line approach in patients with refractory malignant ascites. Care and regular follow-up is indicated following insertion of the drain in all patients, especially those on chemotherapy and those with a pre-procedure diagnosis of renal disease.

Abstract 3445: Helicobacter pylori increases the risk of colorectal polyps in African Americans

Abstract Background: H. Pylori infection have linked to colorectal polyps, mainly through hypergastrinemia and its trophic effect on colon mucosa. African Americans were under represented despite both common diseases are more prevalent in them. Aim: The aim of this study was to investigate whether H. Pylori infection has a role in development of colorectal polyps in Africans Americans. Methods: Retrospectively, Africans Americans (n=1262) greater than 40 years old who underwent bidirectional gastrointestinal endoscopy on the same day were enrolled. The pre-procedure indication and post-procedure diagnosis were recorded (n=1262). H. Pylori status was assessed by immunohistochemistry on gastric specimens. Colorectal polyps were confirmed by histological examination of biopsies from complete colonoscopy. Multivariable logistic regression was used to assess the independent risk factors of polyp occurrence. Results: Colorectal polyps (regardless polyp pathology) were more prevalent in H. Pylori-infected subjects (43%; 160/368) compared to (34%; 302/894) uninfected subjects (OR=1.5; 95 %CI=1.2-1.9). Furthermore, there was a trend toward larger polyp size ≥ 1cm in H. Pylori positive patients (P=0.07). There was no difference in histopathology or location of polyps in regard to H. Pylori status. Among the participants, 21 (2%) were defined with baseline above average risk for colorectal polyps justifying colonoscopy and of those; the polyps were detected in 62% (OR; 95%CI=2.9; 1.2-7.1). Age and male gender were independent risk factors for colorectal polyps. Conclusion: H. Pylori increases the risk of developing colorectal polyps and may increase the chances for having a larger size polyp in Africans Americans. These findings suggest that H. Pylori might have a role in the initiation and/or promotion of polyps. Further studies are needed to explore its mechanisms. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3445.

Abstract 2713: Helicobacter pylori increases the risk of colorectal polyps in African Americans

Abstract Background: H. Pylori infection have linked to colorectal polyps, mainly through hypergastrinemia and its trophic effect on colon mucosa. African Americans were under represented despite both common diseases are more prevalent in them. Aim: The aim of this study was to investigate whether H. Pylori infection has a role in development of colorectal polyps in Africans Americans. Methods: Retrospectively, Africans Americans (n=1262) greater than 40 years old who underwent bidirectional gastrointestinal endoscopy on the same day were enrolled. The pre-procedure indication and post-procedure diagnosis were recorded (n=1262). H. Pylori status was assessed by immunohistochemistry on gastric specimens. Colorectal polyps were confirmed by histological examination of biopsies from complete colonoscopy. Multivariable logistic regression was used to assess the independent risk factors of polyp occurrence. Results: Colorectal polyps (regardless polyp pathology) were more prevalent in H. Pylori-infected subjects (43%; 160/368) compared to (34%; 302/894) uninfected subjects (OR=1.5; 95 %CI=1.2-1.9). Furthermore, there was a trend toward larger polyp size ≥ 1cm in H. Pylori positive patients (P=0.07). There was no difference in histopathology or location of polyps in regard to H. Pylori status. Among the participants, 21 (2%) were defined with baseline above average risk for colorectal polyps justifying colonoscopy and of those; the polyps were detected in 62% (OR; 95%CI=2.9; 1.2-7.1). Age and male gender were independent risk factors for colorectal polyps. Conclusion: H. Pylori increases the risk of developing colorectal polyps and may increase the chances for having a larger size polyp in Africans Americans. These findings suggest that H. Pylori might have a role in the initiation and/or promotion of polyps. Further studies are needed to explore its mechanisms. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2713.

Evolution of transcatheter closure of perimembranous ventricular septal defects in a single centre

To describe the evolution of transcatheter closure of perimembranous ventricular septal defects (PMVSD) using either the Amplatzer membranous or muscular occluders in a single centre. Retrospective analysis of all patients referred for transcatheter PMVSD closure from December 2003 to December 2007. All patients met unit criteria for surgical closure. There were 27 procedures on 25 patients (11 male) with a preprocedure diagnosis of a PMVSD. Median age was 9.6 years (1.8-32.8). Median weight was 28 kg (10.2-86). Defect size on TOE ranged from 5 to 12 mm. Median Qp:Qs was 1.6:1. A muscular occluder was used in six patients. Median procedure time was 93.5 min (51-214). Implantation was ultimately successful in 23 patients (92%). Acute aortic incompetence resulting in occluder removal occurred in two cases, one requiring surgical removal. Another patient had an aborted attempt but had subsequent successful closure in another unit. Median follow-up is 19.5 months (1-42). Five patients (22%) have trivial/mild residual leak across the occluder at their latest assessment, the majority of which had an aneurysmal perimembranous septum (n = 4). Two patients (8%) developed new trivial to mild aortic incompetence. To date, none of the patients in our group have developed complete heart block. Transcatheter closure of PMVSD is evolving and should be considered an acceptable alternative to surgery in selected subgroups. Avoidance of oversized occluders and use of muscular occluders in those with aneurysmal defects may help to avoid heart block and aortic regurgitation. Muscular occluders may however interfere with tricuspid valve function.

Capsule Endoscopy in Children: Overall Usefulness and Special Value in Intestinal Crohn's Disease

Objective: To review the experience with Capsule Endoscopy (CE) in pediatric population at a tertiary care center focusing on the utility of CE to diagnose small bowel Crohn's disease and assess disease activity. Methods: Thirty four patients aged less than 20 years underwent capsule endoscopy at the Jefferson Digestive Diseases Institute, Philadelphia, PA, for a total of 36 studies between May, 2004 to September, 2006. Pillcam SB (Given Imaging, Yoqneam, Israel) capsule was used in all studies. Medical records were reviewed for demographic data, pre-procedure diagnosis, indications, number of complete and incomplete examinations, gastric and small bowel transit times, findings and complications of CE. Results: Two patients failed to complete the study secondary to retention of capsule in the stomach; requiring endoscopic removal in one case and resulting in vomiting of the capsule in other. These patients were excluded from final analysis which represents experience from 32 patients and 34 studies. Mean age of patients was 14 years (Range:7-19 years). Females comprised 62.5% of all patients. Indications included abdominal pain (19 of 34, 56% studies), GI bleeding (47%), diarrhea (41%), anemia (35%) and weight loss/failure to thrive (9%). Capsule was easily swallowed by all patients. Mean gastric transit time was 42 minutes. Capsule failed to visualize the cecum in 18% studies. All 34 capsules were excreted spontaneously and no complications like abdominal pain, bowel obstruction or bleeding were observed. Abnormal findings were seen in 25 of 34 (74%) studies. Crohn's disease activity, in the form of aphthae, linear and serpiginous ulcers, and fissures involving distal small bowel was visualized in 3 of 5 (60%) patients with already diagnosed Crohn's disease involving small and/or large intestine. Four patients who were overall negative for Crohn's disease using conventional radiographic and endoscopic studies had diagnostic findings consistent with Crohn's disease on CE. These findings were most commonly located in the ileum, but also involved duodenum and jejunum. Other abnormal capsule findings included erythema (in 21% of 34 studies), erosions (18%), fresh blood (15%), ulcers (15%), gastritis (15%) and mucosal fold thickening (12%). Conclusion:A) Capsule endoscopy is a safe and valuable diagnostic tool in pediatric population with a potential to expedite diagnosis and treatment of small bowel disease similar to the adult experience. B) Capsule endoscopy is especially useful in detecting the presence, activity and severity of small bowel Crohn's disease. C) Capsule endoscopy offers the possibility of improved diagnosis while limiting radiation exposure in children with Crohn's disease.

ERCP/Manometry Findings Based Upon Pre-Procedure Diagnosis: A Sub-Group Analysis of 1,343 Idiopathic Pancreatitis Patients

Background: ERCP with sphincter of Oddi manometry can detect abnormalities in patients otherwise classified as idiopathic pancreatitis. Methods: All patients undergoing ERCP at Indiana University Medical Center have data prospectively entered into a database. 1,547 patients from 1994-2006 were classified initially as idiopathic pancreatitis. After review of medical history, non-invasive imaging, prior endoscopies, and blood studies, 204 patients were eliminated for known causes of pancreatitis. This study reviews the findings of ERCP with or without manometry of the remaining 1,343 patients in correlation with the pre-ERCP clinical diagnosis.

Accuracy of Hyperband EUS in the Assessment of Early Neoplasia in Barrett's Esophagus: A Prospective Cohort Study

Rationale: Routine radial EUS has been felt to be inadequate to stage early neoplasia in Barrett's Esophagus (BE). The hyperband (Olympus GF-UM 160) echoendoscope using composite piezo-electric material provides broadband scanning using four different frequencies, resulting in high-resolution ultrasound images. The yield and accuracy of this instrument in the assessment of early neoplasia in BE has not been reported previously. Aim: To assess the accuracy of the GF-UM 160 echoendoscope in the staging of neoplastic lesions arising in BE using endoscopic resection (EMR) specimen pathology as the gold standard in a prospective study. Methods: A prospective cohort of 77 patients with HGD/Carcinoma and BE seen at the Mayo Clinic was studied. All patients underwent a standard protocol assessment with EGD, 4 quadrant biopsies every centimeter. Visible lesions were resected using either the Olympus EMR kit (70%) or the Wilson-Cook Duette Multi-Band mucosectomy system (30%). Staging was performed prior to resection in all patients using the Olympus GF-UM 160 instrument by a single experienced endosonographer. Results: 77 patients were studied. 58 (75%) were males. The median age was 69 years (IQR 61, 76). The pre-procedure diagnosis was HGD in 49 patients (64%) and cancer in the remainder (36%). The median BE segment length was 3 cm (IQR 1, 7). 73% of patients had a visible nodule/mucosal irregularity on EGD. Staging with EUS revealed no abnormality (uT0) in 61 (77%) patients, uT1 disease in 15 (9%) patients (mucosal [uT1a] in 8 patients and submucosal [uT1b] in 7 patients), and uT2 disease in 3 patients (4%). No patients had metastatic lymph nodes. EMR pathology revealed carcinoma in 20 patients (submucosal in 7; mucosal in 13). 44% of the resected lesions contained HGD. 3 of the 13 (23%) mucosal cancers and 2 of 7 (28%) submucosal cancers were correctly staged, with the remaining being under or over staged. 4 patients with submucosal cancer underwent esophagectomy, 2 continued with endoscopic therapy alone and one patient opted for comfort care only. Conclusions: The sensitivity of Hyperband EUS in detecting cancers was 70% with a specificity of 93%. This compares favorably with prior reports of endosonographic identification and staging of early neoplasia in Barrett's esophagus. Hyperband EUS accurately predicted EMR respectability of lesions in all patients. However accuracy of staging superficial cancers as mucosal or submucosal remained limited, when compared to staging following EMR.