Abstracts

fluoroscopy and is a useful device for evaluating efficacy of ETM. 2. Most pts(89.1%) required ETM to examine entire colon, and when ETM were required toreach C, 2.95 ETM/pt used. 3. While left sided issues account for majority of needfor ETM at 72.6%, Trans Loop 9.0% and Hepatic Flex Ang 9.9% are also significantreasons for ETM. 4. When the scope tip was in the Trans, Hepatic Flex, andAscending, ETM success rates were less than in the left colon.

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Propofol Versus Conscious Sedation Use and the Yield of Lesions

Found During Initial Screening ColonoscopyCherag Daruwala, Giancarlo Mercogliano, Melissa MorganBackground: Endoscopic sedation has recently attracted growing attention fromboth gastroenterologists and patients because of its effect on the efficiency andoutcome of endoscopy. Objective: The purpose of this study is to analyze the yieldof lesions found during screening colonoscopy under conscious sedation(benzodiazepine þ opiod) and compare it to the yield found using monitoredanesthesia care (MAC) with propofol. Design: Retrospective data review. Setting:Single tertiary care center. Patients and Interventions: The study populationconsisted of 98 patients who underwent screening colonoscopy under conscioussedation matched to 98 patients screened under MAC with propofol matched byage, sex, and endoscopist. Main Outcome Measurements: The primary focus of thestudy was to compare the prevalence of colorectal polyps between the two groups.Results: Overall, the prevalence of polyps in the propofol group was 26.5%compared to 20.4% in the conscious sedation group (p Z 0.31). The prevalence ofadenomatous polyps was 16.3% in the propofol group compared to 14.3% in theconscious sedation group (p Z 0.70). In addition to the polyp analysis, we foundno statistical difference in the prevalence of cancer, diverticulosis, internalhemorrhoids, vascular ectasia, incomplete procedures and rate of cardiovascular/pulmonary complications. Limitations: Relatively small number of patients.Conclusion: There does not appear to be any statistically significant difference inthe prevalence of colorectal polyps or other clinically significant lesions in patientsundergoing screening colonoscopy under conscious sedation witha benzodiazepine and opiod compared to MAC with propofol.

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Effectiveness and Safety of Self Expanding Metal Stents for

Colonic Obstruction Due to Extra-Colonic MalignanciesKunal Gupta, Jesse P. Houghton, Eric Shen, Tamir Ben-MenachemBackground: Self expanding metal stents (SEMS) are effective for palliation ofobstruction due to colon cancer. However, very little is known regarding the use ofSEMS for colonic obstruction due to extra-colonic malignancies. We retrospectivelyreviewed our experience with SEMS for palliation of colonic obstruction due tonon-colonic malignancies. Methods: Between October 2003 and January 2007, 24patients had 30 procedures to place 38 SEMS across 31 strictures. All procedureswere performed with sedation or general anesthesia, using standard endoscopictechniques under fluoroscopic guidance. Procedural success was defined if threeoutcomes were achieved: Adequate deployment of a SEMS; adequate palliation ofcolonic obstruction within a week; and no resultant mortality within a week of theprocedure. Results: Twenty patients (83%) were female. The mean age was 60 � 11years. Primary neoplasms were ovarian (9), cervical (4), uterine (2), endometrial(2), bladder (3), pancreas (2) and sarcoma (2). Clinically, 58% had partialobstruction, 42% complete obstruction, and 16% had recto-vaginal fistulae. Onestricture was seen in 75% of patients, while 25% had two distinct levels of colonicobstruction. Obstruction sites were transverse colon (19%), left colon (66%), andrectum (15%). The stricture lengths were: ! 5 cm (33%), 5-10 cm (48%), and O 10cm (19%). Strictures were categorized as: straight (25%), single severe angulation(33%), or tortuous/multiangled (42%). Balloon dilation was required for 36% ofstrictures. When successful, 19 strictures required one SEMS, 5 strictures requiredtwo SEMS, and 3 strictures required 3 SEMS for adequate luminal patency. A varietyof SEMS were used, including: Wallstent enteral, Wallflex colonic, Ultraflex coveredesophageal, and Z-stent covered esophageal stents. Twenty of 30 (66%) procedureswere successful. Reasons for failure included: 4 strictures could not be stented, 4patients required a venting gastrostomy or diverting colostomy and 2 expiredwithin a week due to perforation. Three additional patients required a ventinggastrostomy or surgery within a month despite patent stents. The incidence ofmajor complications was 13% (2 expired, 2 had respiratory failure). The incidenceof pain, stent migration, fever and bleeding was 63%. Conclusions: Endoscopicplacement of SEMS for colonic obstruction due to extra-colonic malignancies is aneffective method of palliation. However, these complex strictures frequently requiremore than one SEMS to achieve luminal patency, and may be associated witha significant risk of complications.

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Transanal Endoscopic Microsurgery Performed By a Medical

GastroenterologistShyam Varadarajulu, Ernesto R. DrelichmanBackground: Transanal endoscopic microsurgery (TEM) is a minimally invasivealternative to low anterior resection for management of large sessile polyps and

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early stage cancers in the rectum. However, TEM is currently being performed onlyby surgeons. Aim: Assess the feasibility for a medical gastroenterologist (GI) to betechnically competent in performing TEM. Methods: This is an ongoing prospectivestudy undertaken by an interventional GI and a colorectal surgeon over an 8-monthperiod. Patients were referred for TEM by gastroenterologists and surgeons forresection of large sessile polyps or early stage cancer in the rectum that were notamenable for polypectomy or EMR. Preoperative rectal EUS was performed in allpatients; In patients with rectal cancer, only those with T1 disease and without peri-rectal lymph nodes were included. The GI has lifetime experience of performingO 3000 colonoscopies and the surgeon O 3000 colorectal surgeries. Training: TheGI 1) underwent three 2 hr sessions of simulator training to gain familiarity with useof laparoscopic equipments, 2) underwent three 4 hour training sessions in ananimal lab to practice basic surgical techniques, 3) underwent one 3-hr on-handstraining program with TEM equipment in an animal lab, 4) assisted the colorectalsurgeon in performing five TEM cases on humans, and 5) was then temporarilycredentialed to perform TEM cases under the supervision of the surgeon. Allprocedures were performed in the operating room under general anesthesia andpatients were admitted post-operatively for 23-hr observation. A follow-upsigmoidoscopy was undertaken at 3-months in all patients. Technical success wasdefined as complete resection of the mass with clear margins at histopathology.Results: Following credentialing, the GI performed 20 cases of TEM. Proceduralindications were, large sessile polyp in the rectum (n Z 15), T1 rectal cancer (n Z4) and rectal carcinoid (n Z 1). The procedure was technically successful in 19 of20 (95%) cases; in 1 case the rectal mass was too large (O 6 cm) requiring a lowanterior resection. Of the 19 cases that were resected successfully, the GI requiredassistance from the surgeon to perform the initial eight cases but was able toperform the later 11 independently. No immediate or late complications wereencountered. At 3-month follow-up, no residual tumor was seen in 18 of 19 patientswho underwent a successful TEM; one patient had recurrent tumor that wasresected by repeat TEM. Conclusions: With adequate training and mentoring, it isfeasible for an experienced gastroenterologist to independently and safely performTransanal Endoscopic Microsurgery.

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Public Perception of the PillCam Colon Versus ColonoscopyWun-Chung Teoh, Shehan Abey, Marie Ooi, Jenny McdonaldBackground and Aim: There is emerging evidence for the utility of the PillCamColon capsule endoscopy (CCE) for population-based screening of colorectalcancer. It was developed as a safe, minimally invasive and patient-friendly methodfor visualising the colon. Our unit evaluated the public acceptance and preferencewith regards to this modality and the gold standard colonoscopy. Methods:Outpatients and non-patients were randomly surveyed with a self-administeredquestionnaire. Indications, descriptions and comparisons between each procedurewere provided. Patient preference, reason for choice, medical background,education level, and health status were evaluated. Results: A total of 164 surveyswere returned. The average age was 58.4 years with 59 males. Twelve percent werenon-patients, 32% had tertiary education, and 11% felt that they were in poorhealth. Seventeen percent were unsure of previous polyp status but only 3% wereunsure of prior colonoscopy status. The preference was split with 41% opting forcolonoscopy, 40% opting CCE, and 19% undecided. Common reasons for choosingcolonoscopy were the possibility of intervention (28%), previous colonoscopyexperience (24%), and better detection rates (13%). Reasons for opting CCE werethe lower invasiveness (22%), ease and comfort (22%), lower risk (15%) and thelack of anaesthetic (15%). Using logistic regression, prior colonoscopy waspredictive of a lower likelihood in choosing CCE (odds ratio, 0.41; P Z 0.015). Age,sex, level of health, patient status, education level, home internet, previous polyps,bowel cancer, family history of bowel cancer and a medical background were notpredictive. Conclusions: Based on the split in preference and the number ofundecided answers, it appears that patient preference will not influence the successof the PillCam CCE. No factor apart from prior colonoscopy experience waspredictive of patient preference. The choice of investigation should be based onindividual clinical factors rather than patient preference.

W1598

Successful Treatment of Anastomotic Leakage After Lower

Anterior Rectum Resection (LAR) By Endoluminale

Polyurethane (PU)-Sponge Vacuum TherapyBodo Schniewind, Frank Bokelmann, Volker Kahlke, Jan H. Egberts,Clemens Schafmayer, Horst Grimm, Fred FaendrichIntroduction: Morbidity and mortality after lower anterior rectum resection isessentially determined by anastomotic leakage. The reported leakage rates inliterature vary between 2 and 27 percent. In case of clinical apparent leakagetherapy is time consuming and incriminatory for the patient. Methods: Form 07/2006 to 11/2007 16 patients after LAR were treated by a new endoscopic guidedendoluminale vacuum PU-sponge therapy. Anastomotic leakage was confirmed byendoscopy. All patients received a double loop enterostoma prior to furthertreatment. Afterwards anastomotic wound cavity was intubated by the endoscopeand after irrigation an overtube was placed in the cavity under visual control. The

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