Abstracts

W1526

Bridge to Surgery Stenting in Patients with Malignant Colonic

Obstruction Using the WallFlex Colonic Stent: Report of

a Prospective Multicenter RegistryJavier JimeNez-PeRez, Juan Antonio Casellas, Jesus Garcıa-Cano,Alberto Alvarez, Javier Barcenilla, Pedro GonzaLez, Enrique VaZquez,Leopoldo LoPez-Roses, Luis YugueroBackground: Emergency surgical treatment of acute malignant colonic obstructionis associated with a high morbidity and mortality rate and patients often end upwith a temporary or permanent stoma. Endoscopic colonic stent insertion caneffectively decompress the obstructed colon allowing bowel preparation andelective resection with primary anastomosis. Aim: To assess the effectiveness andsafety of WallFlex colonic stent (Boston Scientific,Natick,USA) in patients withacute malignant colonic obstruction suitable of curative tumoral resection. Materialand Method: A multicenter registry documenting the performance of WallFlexcolonic nitinol self-expanding metal stent will enroll 200 patients in Spain,includingboth palliative and bridge to surgery (BTS) indications. Interim results on the BTSgroup are presented. Patients are followed until surgery. Technical success(adequate stent placement and expansion),clinical success (improvement inpassage of stool without reintervention from baseline to surgery), safety(procedural and postprocedural complications) and surgery outcomes areevaluated. Results: 64 BTS patients (38 males;mean age 71) were included. Alltumors were intrinsic and located at the rectum (7.8%), recto-sigmoid junction(7.8%), sigmoid colon (43.8%), descending colon (29.7%), splenic flexure (7.8%),transverse colon (1.6%) and hepatic flexure (1.6%). 61 patients (95.3%) presentedwith sub-occlusive symptoms or complete obstruction. Technical success wasachieved in 61/64 (95.3%). Failures were due to improper stent placement (2) andimproper stent expansion (1). Clinical success was achieved in 61/64 (95.3%).Failures were due to colonic perforation in 2 patients and stent obstruction due tofecal impaction in 1 case. Procedural complications (during or within 6 hours ofplacement) occurred in 4 patients (6.2%): perforation (1), bleeding (1), fever (1)and abdominal pain (1). Post-procedure complications (between stent placementand surgery) occurred in 3 patients (4.6%): perforation (1), migration (1) and fecalimpaction (1). One patient died because of colonic perforation after stenting(1.6%). Elective resection could be performed in 60 patients (93.7%) with primaryanastomosis in 58 of them (90.6%). Mean time between stent placement andsurgery was 16 days (range:2-52). Conclusions: 1. WallFlex colonic stent is effectivein patients with acute malignant colonic obstruction as a bridge to surgerytreatment, restoring luminal patency and allowing elective surgical resection withprimary anastomosis. 2. The use of this stent is safe and associated with anacceptable complication rate, considering reported data about other stents andemergency surgical treatment.

W1527

Screening for Colorectal Neoplasia in Those Undergoing

Evaluation for Solid Organ Transplantation: Does It Alter the

Clinical Management?Moises Garcia, Ramanujan Samavedy, Susan Partington, Jeffery Steers,Marc F. Catalano, Joseph E. Geenen, Nalini M. GudaBackground: Colorectal neoplasia is the second most leading cause of cancerrelated mortality. Individuals undergoing solid organ transplant are believed to havesimilar risk for colorectal neoplasia as general population. Screening for colorectalneoplasia by invasive techniques as colonoscopy is difficult in those who aredecompensated secondary to organ failure. Data regarding the utility and safety inthis population is scant. Aim: To determine the incidence of advanced neoplasia(large adenomas, tubulovillous adenomas, carcinoma in situ or advanced cancers)in those undergoing pretransplant screening colonoscopy as these are likely tochange the outcomes. 2. To analyze the safety of screening colonoscopy in thoseundergoing work up for solid organ transplant. Methods: All patients undergoingevaluation for solid organ transplant (liver, kidney, heart, pancreas and lungs) ata large tertiary care center were analyzed. Results: Of those being evaluatedbetween Jan 2003 and June 2007, 187 underwent colonoscopy and 205 did notsince they were not over 50 and did not have any risk factor that would warrant anearlier examination. Of those who did undergo colonoscopies 23 were under 50and hence excluded from analysis. Thirty-seven had colonoscopies done forevaluation of symptoms (abdominal pain: 3, rectal bleeding: 4, anemia: 8, bloodystools: 9, history of polyps: 6, other symptoms: 7) and were excluded as well. Of the137 with average risk for colorectal neoplasia undergoing screening examinations,colonoscopy was completed in 97%. Most tolerated the prep (PEG solution) asevidenced by good to excellent prep (96%) as reported by the colonoscopists. Allpatients were sedated by a registered nurse or by monitored anesthesia. Oxygensaturation, continuous cardiac rhythm, blood pressures were monitored. Noimmediate complications were reported and the procedure was tolerated well.Adenomatous lesions were seen in 28%. Significant lesions that would alter theclinical outcomes were seen in 3 patients (adeoncarcinoma, high grade dysplasia ina polyp, lymphoma). Conclusions: 1. The incidence of adenomatous lesions asexpected is similar to that of general population. 2. Colonoscopy could be safelyperformed in those undergoing pretransplant evaluation. 3. Over 2% have anadvanced neoplastic lesion which would alter the clinical management and hence

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one should continue to do screening examinations especially given the scarcity ofdonor organs.

# Adenomas Advanced Neoplasia

lume 67, N

o. 5 : 2008 GASTROINTEST

Pt’s

No % No

INAL ENDOSCOPY

%

137

38 28% 3 2.2

W1528

A Female Predominance in the Time-Dependent Proximal Sfift in

Colorectal Cancer in the USAGraham Barnard, Jay J. YaminBackground: The incidence and trends of colorectal cancer (CRC) differ worldwide.Women in the USA appear to have a greater proportion of advanced adenomasproximally than do men. We hypothesized that a similar distribution bias should bepresent in CRC. Methods: We retrospectively reviewed CRC data from 1980-2004. Atthe University of Massachusetts-Memorial Health Care system a total of 2327 caseswere reviewed. Massachusetts is an area where the incidence of CRC is declining.Results: Women had a greater proportion of CRC proximal to the splenic flexurethan did men, 48-43% (p ! 0.01) in the USA. A pronounced time-dependentproximal shift from 1980-2004 was much more marked in women than in men. Theshift for women in the USA was 34-53% (p ! 0.001) of CRC being right-sidedcomparing 1980-89 to 2000-2004 respectively, whereas for men it was 36-45%. Thereis also an age-related rightward or proximal shift in CRC. In patients !59 years ofage, 37% of CRC were proximal in the USA; whereas in patients O80 years of age57% of CRC were proximal to the splenic flexure (p ! 0.001) although thisprobably does not fully explain the time-dependent shift. Older patients were morelikely to present with an earlier stage of disease with 60-63% (p ! 0.002) of patientsaged O80 presenting with stage 0-II disease and 46-55% (p ! 0.002) of patientsaged !59 presenting with stage 0-II disease. Conclusions: The proximal shift inCRC over time has affected women more than men in the USA. There areimplications for gender differences in CRC screening guidelines. Increasinglywomen may be better screened by methods assessing the entire colon.

W1529

Endoscopic Decision of Complete Resection Is More Practical

Than Pathologic Decision in the Endoscopic Resection for Rectal

CarcinoidsCheol Hee Park, Dong Kyung Chang, Sang Kil Lee, Jin-Oh Kim, Byung-Ik Jang, Jeong Eun Shin, Sung Jae Shin, Yoon Tae Jeen, Jeong-Seon Ji,Suck-Ho Lee, Sung-Ae Jung, Dongil Park, Chang Soo Eun, Il Hyun BaekBackground/Aim: Rectal carcinoids are often described as low-grade malignancyand are usually treated by endoscopic resection. However, reports on the outcomesof endoscopic resection for rectal carcinoids remain limited to several single-institution studies. We reviewed the experiences of endoscopic resection for rectalcarcinoids in Korea. Methods: This study retrospectively analyzed the medicalrecords of 409 patients with rectal carcinoid at 14 university hospitals in Korea fromJanuary 1999 until June 2007 in the aspects of age, sex, tumor size, completeresection, invasion, recurrence, and complications. Residual disease wasdetermined when carcinoid tumor cells were detected histologically at theresection site in 6 months after endoscopic resection. Results: The mean age atdiagnosis was 50 years (range 15-90). Male to female ratio was 1.1: 1. The rectalcarcinoids were measured 7.66 � 4.96 mm in maximal diameter. Three hundredfifty-four patients were treated with endoscopic resection, whereas 55 patientsunderwent operation. In the endoscopic resection group, complete resection rateswere 88.9% based on the endoscopic appearance (CR-E) and 59.3% based on thepathologic evaluation (CR-P). The agreement between CR-E and CR-P was low (k Z0.188). In 83 of 88 patients (94%) whose disease were defined CR-E but were notachieved CR-P, residual diseases were not found on 6 months follow-up endoscopicbiopsy. Complications of endoscopic resection occurred in 13 patients, but weremanaged endoscopically in all cases. The median follow-up period was 26 months(range 6-147). Local recurrence developed in 2 of 210 patients who had completeresection. One patient was treated with a second endoscopic resection, and theother patient underwent operation. No recurrence has been reported until 26months follow-up after the second endoscopic resection and operation. The 3-yearoverall survival rate was 100%. There were 14 patients with metastasis at the time ofdiagnosis. Independent factors predicting metastasis were age (p Z 0.0329), tumorsize (p ! 0.001), central depression (p ! 0.001), ulcer (p ! 0.001), lymphaticinvasion (p ! 0.001), and venous invasion (p ! 0.001) in multivariate analysis.Conclusions: Endoscopic resection is an effective therapeutic modality for selectedcases of rectal carcinoids (%10 mm). Discrepancies were observed between CR-Eand CR-P, but CR-E better predicted complete resection state probably becauseendoscopic cauterization might have eradicated minimal tumor cells close to theresected margin. Patients with age, tumor size O10 mm, central depression, ulcer,and lymphatic or vascular invasion have higher metastatic potential.

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