Mo1226Is it Possible to Perform Safe Endoscopic Submucosal Dissectionat a Small Clinic? Based on Our Experience With 1047 CasesNaondo Sohara*1, Satoshi Hagiwara1, Riki Arai1, Satoru Kakizaki2,Yasuhiro Onozato1

1Department of Endoscopy and Endoscopic Surgery, Shirakawa Clinic,Maebashi, Japan; 2Department of Medicine and Molecular Science,Gunma University, Maebashi, JapanBackground: Endoscopic submucosal dissection (ESD) is accepted as a minimallyinvasive treatment for gastrointestinal cancer. However, it is usually performed ingeneral hospital because of the high frequency of complications as well as theneed for a high level of technical skill. The Shirakawa clinic was founded as aspecial clinic for endoscopic surgery, with 19 inpatient beds. This studyinvestigated whether ESD can be safely performed at such small clinics. Patientsand Methods: 1047 ESDs for gastrointestinal tumors were carried out in theShirakawa clinic from April 2006 to March 2011. The efficacy, technicalfeasibility, and complications were assessed. ESD procedures were performed by5 endoscopists. Sedation was performed using propofol foresophagogastorduodenal ESD. Results: The 1047 ESDs were performed to resect64 esophageal cancers (E), 850 gastric tumors (G, 760 cancers, 82 adenomas and4 others), 4 duodenal cancers (D) and 129 colorectal tumors (C, 94 cancers, 21adenomas and 14 others). The en-bloc resection rate was 94.3% (E; 96.9%, G;95.8%, D; 100%, C; 79.8%). The median operation time was 46 minutes (range 4to 360) and the mean size of the resected specimens was 18mm (range: 2 to150mm). No mortal complications were observed in association with the ESDprocedures. Perforations occurred in 12 cases (1.1%, E; 1 case, G; 8 cases, D; 1case, C; 1 case) and postoperative bleeding in 53 cases (5.1%, G; 51 cases, D; 1case, C; 1 case), but no case required emergency surgery or blood transfusion.All of the perforations were resolved by endoscopic clipping or hemostasis. Theother problematic complication was pneumonia, which was treated withconservative therapy. There were no other serious complications or fatal cases.Conclusions: ESD was associated with some problematic complications.However, all complications were resolved by non surgical therapy includingendoscopic clipping, etc. ESD can be performed safely in a clinic that hasestablished adequate therapeutic methods and medical services to addresspotential complications.

Mo1227Revisit of Prokinetics in Colonoscopic Bowel Preparation WithSplit Dose of PEGTae Oh Kim*, Eun Hee Seo, Jongha Park, Young Soo MoonInternal Medicine, Haeundae Paik Hospital, Inje University College ofMedicine, Busan, Republic of KoreaObjectives: Nowadays, split dose of PEG is mainstay of bowel preparation for itsbetter tolerability, better bowel cleansing state and safety. Nonetheless, aproportion of suboptimal preparation that has several consequences, includingreduced polyp detection rate and more strenuous colon inspection, was stillpresent. There were a few incomplete trials with prokinetics to improve bowelpreparation. The aim of our study was to compare the efficacy of bowelcleansing achieved by administering sufficiently prokinetics, itopride (10mg),twice to split dose PEG with that of split dose PEG without prokinetics. Methods:A prospective endoscopist-blinded study was conducted, in which patientsundergoing morning colonoscopy were randomized to receive either Spilt dose ofPEG with prokinetics or split dose of PEG without prokinetics. Dose of Prokinetics,ITOPRIDE was two tablets (10mg) and was taken twice, simultaneously with each ofsplit dose of PEG. Bowel cleansing efficacy was scored by blinded endoscopistusing the Ottawa scale and segmental fluidity score scale and each participant filledout bowel preparation survey. Mean scores for each bowel segment, compositemean score, rate of poor preparation inferred from Ottawa scale and segmental fluidscore were compared between the two groups. Results: A total of 142 patients(mean age 50.7 year, 46% male) evenly distributed between the two groups.Patients in the split dose of PEG with prokinetics have significantly lower Ltcolon, total Ottawa scale score and segmental fluid score when compared withsplit dose of PEG without prokinetics.(P�0.05). There was no difference in thestudy groups on polyp detection rate, adenoma detection rate and uncomfortableabdominal symptom experienced during colonoscopy preparation. Conclusions:This study reveals that prokinetics with split dose of PEG has efficacy in bowelcleansing for morning colonoscopy when administered sufficiently. It was largelyresulted from decreased fluidity of bowel.

Mo1228Optimal Range of Bispectral Index Monitoring for BalancedPropofol Sedation During ColonoscopyYeon Hwa Yu*, Dong Soo Han, Eun Kyoung Kim, Hyun Soo KimHanyang University College of Medicine, Guri, Korea, Guri, Republicof KoreaObjectives: The purpose of this study was to evaluate the optimal cut-off valueof bispectral index monitoring (BIS) for moderate sedation, balanced propofol

sedation (BPS) in outpatients during colonoscopy. Patients and Methods: A totalof 30 consecutive patients (ASA I - II), receiving BPS with low-dose midazolamand propofol during colonoscopy, were evaluated. BIS and the ModifiedObserver’s Assessment of Alertness/Sedation (MOAA/S) scores were recoredevery 1 min by single trained observer. And the effectiveness and safety ofsedation were evaluated. Results: There was a positive correlation between BISand MOAA/S scores (r� 0.66, p�0.001). Considering the clustering of the datadue to multiple measurements for the same patients, the optimal cut-off value ofBIS for the detection of moderate sedation (MOAA/S�3) was 81 and AUC valuesof ROC curves for prediction MOAA/S�3 was 0.88 (95% CI 0.82-0.93). The meantotal dose of midazolam was 1.83 � 0.38mg (1.00-2.00mg), and the mean totaldose of propofol administered was 49.16 � 31.21mg (20.00-170.00mg).Endoscopists and patients showed high satisfaction. There were no significantcomplication except for temporary hypoxemia. Conclusions: The optimal cut-offvalue of BIS for the detection of moderate sedation is to be 81. For endoscopistswho focus on procedures in clinical practices, BIS monitoring would be helpfulin the decision making of additional administration of propofol.

Mo1229Scope to Improve: A Multi-Centre Audit of 16064 ColonoscopiesLooking at Caecal Intubation Rates, Over a Two-Year PeriodAjay Verma*1,2, Nadine Mcgrath1, Paula Bennett3, John Decaestecker2,Andrew Dixon1, Jayne Eaden3, Peter Wurm2, Andrew P. Chilton1

1Gastroenterology, Kettering General Hospital NHS Foundation Trust,Kettering, United Kingdom; 2Gastroenterology, University HospitalsLeicester NHS Trust, Leicester, United Kingdom; 3Gastroenterology,University Hospitals Coventry and Warwickshire NHS Trust, Coventry,United KingdomIntroduction: Colonoscopy is the gold standard assessment for large bowelmucosal pathology, but a complete examination is an essential requirement. Thefirst national colonoscopy audit carried out in 1999 demonstrated caecalintubation rates (CIRs) of 56.9%, which the authors described as “unacceptablylow”. As a result the Joint Advisory Group on Gastrointestinal endoscopy (JAG)launched a programme of continuous quality improvement by standardisingtraining, peer review and audit. JAG recommends practitioners undertake at least100 procedures per annum with target CIRs of 90%. The current audit providesan assessment of performance against these quality standards. Aims & Methods:Data was collected from all procedures undertaken in 2008-09 from 6 hospitalsacross 3 English regions. The data included grade and specialism of operator,number of procedures and CIRs. Caecal intubation was recorded if reportspositively documented reaching defined landmarks. Results: 16064 colonoscopiesperformed with a CIR of 90.57% (95% CI: 90.11-91.01%) Operators doing 100�procedures per annum. CIR � 91.76% (95% CI: 91.24-92.25%) Operators doing �100procedures per annum � 87.77% (86.82-88.67%) Gastroenterologists � 91.01%(90.32-91.70%) Surgeons � 91.03% (90.27-91.79%) Others practitioners � 81.51%(78.79-84.22%) Bowel cancer screening colonoscopies � 97.71% (97.07-98.34%)Non-screening colonoscopies � 88.31% (95% CI: 87.68-88.94%). Conclusion: Thisaudit of 16,064 colonoscopies over 3 regions demonstrates aggregatedachievement of the CIR quality standard, which is evidence of the effects ofimprovements in training and the implementation of standards introduced byJAG since the 1999 national audit of colonoscopy. There is, however, asignificant performance gap when comparing BCSP colonoscopists with non-screening colonoscopists and the CIR of greater than 90% is supported by thevolume of BCS colonoscopy work load. Endoscopists performing low volumecolonoscopy, �100 procedures per annum, have a CIR of �90%. Endoscopistwith low volume practice who does not meet the quality standards shouldengage in skills augmentation plus further training and increase the numbersof procedures performed with local mentorship, or stop performingcolonoscopy.

Mo1230Follow-Up Colonoscopy After a Negative Colonoscopy; Is itFollowed by Guideline?Hyun Gun Kim*, Seong Ran Jeon, Jin-Oh Kim, Bong Min Ko,Wan Jung Kim, Won Young Cho, Tae Hee Lee, Joo Young Cho,Moon Sung Lee, Joon Seong LeeInstitution for Digestive Research, Department of Internal Medicine,Soonchunhyang University, College of Medicine, Seoul, Republic ofKoreaObjectives: Although a follow-up interval of 5 to 10 years after a negativecolonoscopy has been recommended, there is a tendency to perform a follow-upcolonoscopy with shorter interval than recommendation. This study aimed toevaluate the follow-up interval after a negative colonoscopy in usual clinicalpractice and investigate the characteristics of advanced colorectal lesions onfollow-up colonoscopy. Methods: A retrospective chart review of 1570individuals aged over 40 who had a negative colonoscopy (index colonoscopy)

Abstracts

AB357 GASTROINTESTINAL ENDOSCOPY Volume 75, No. 4S : 2012 www.giejournal.org