Abstracts

significantly shorter in patients with EPLBD (54 minutes than in patients without(102 minutes, p!0.05). Two patients treated with EPLBD (18%) experienced PEP(post-ERCP pancreatitis). Duringt the follow-up period with a mean of 528 days, bileduct stone recurred in a case (9.%). Conclusion: EPLBD under DB-ERCP is aneffective and safe treatment procedure for common bile duct stone in patients withreconstructed intestine.

Su1671Utility and Problems of Linear Array EUS and ERCP for Diagnosisand Treatment of Acute Cholangitis in Over 80 Years High ElderlyPatientsDaisuke Masuda*1, Akira Imoto1, Takeshi Ogura1, Ken Narabayashi1,Sadaharu Nouda1, Toshihiko Okada1, Kumi Ishida1, Yosuke Abe1,Toshihisa Takeuchi1, Takuya Inoue1, Michiaki Takii2, Eiji Umegaki1,Kazuhide Higuchi11The second department of internal medicine, Osaka Medical College,Takatsuki City, Osaka, Japan; 2The Faculty of Nursing, Osaka MedicalCollege, Takatsuki City, Osaka, JapanBackground & Aim: The clinical diagnostic and therapeutic strategy was publishedwith "The Japanese clinical guidelines on the clinical management of patients withacute cholangitis" in 2005, and "Tokyo Guideline for the management of acutecholangitis" in 2007. "Updated Tokyo Guidelines" was revised in 2013 for promotionthe integrity of the divergence between 2 previous guidelines. The early appropriatediagnosis and therapy is needed for acute cholangitis (AC), then endoscopicaldiagnosis and treatment are indispensable for clinical management of AC. In thisstudy, we evaluate of the utility and problems of endoscopical diagnosis and treat-ment for AC in high elderly patients. Patients & Methods: We retrospectively studiedAC cases in Osaka Medical College Hospital. Subjects were 241 patients (Age;69.3 �0.8 years, Gender; male/female 158/83)in from January 2000 until September 2013.Cause of AC was 174 bile duct stone (BDS), 45 malignant biliary stenosis (MBS), and22 benign biliary stenosis (BBS). We classified 2 groups; one was high elderly pa-tients (over 80 years) group (HEPG), the other was non high elderly patients (under79 years) group (NHEPG), and compared clinical symptom/severity, success rate ofbiliary drainage(BD), and complication. Results: 1) HEP was 48 patients, NHEP was193 patients. Cause of AC was 40 BDS, 7MBS, 1BBS in HEP, 134BDS, 38MBS, 21BBSin NEHP. 2) Commodity; EHP/NEHP: 97.9%/76.0%(pZ0.0006), dementia; EHP/NEHP: 43.8%/10.9%(p!0.0001), anticoagulant therapy; EHP/NEHP: 45.8%/26.4%(pZ0.0088), over performance status 2; EHP/NEHP: 75.0%/31.1%(p!0.0001).3) Symptom(EHP/NEHP); Fever: 93.8%/83.4%, abdominal pain: 54.2%/65.8%, jaun-dice: 83.3%/83.9%, history of biliary disease: 27.1%/32.6%, Charcot triad:64.6%/58.0%. There was no significant difference between 2 groups. 4) Severity; rate ofsevere AC was 33.3% in HEP, 15.5% in NHEP (pZ0.0055), rate of moderate AC was47.9% in HEP, 48.2% in NHEP (pZ0.9733), rate of mild AC was 18.8% in HEP, 36.3%in NHEP (pZ0.0205). 5) Since total 20 patients did not undergo ERCP, who included1 severe AC, 93years old woman in HEP, and 19 patients in NHEP, other 221 patientsunderwent EUS or ERCP. Success rate of BD with ERCP was 97.9% in HEP, 95.4% inNHEP (pZ0.4471). 1 failure in BD with ERCP in HEP-BDS, succeeded in EUS-Ren-dez-vous. Success rate of BD with ERCP and additional EUS was 100% in HEP, 98.3%in NHEP (pZ0.3647). 6) Complication; acute pancreatitis was 2.2% (1/47) in HEP,8.6% (15/174) in NHEP (pZ0.1256), aspiration pneumonia was 4.3% (2/47) in HEP,0.6% (1/174) in NHEP (pZ0.0530), one in HEP was dead of aspiration pneumonia.Conclusion: Although over 80 years high elderly patients AC was severer thanyounger AC, EUS and ERCP can be performed safely for over 80 AC as well as foryounger AC. We must take care of aspiration pneumonia after EUS or ERCP for highelderly AC.

Su1672Extracorporeal Shock Wave Lithotripsy for Difficult Common BileDuct Stones: Comparison Between Two Different Lithotripters in aLarge Cohort of PatientsPaolo Cecinato*1, Lorenzo Fuccio1, Francesco Azzaroli1, Andrea Lisotti1,Loredana Correale2, Cesare Hassan3, Federica Buonfiglioli1,Giulio Cariani1, Giuseppe Mazzella1, Franco Bazzoli1, Rosangela Muratori11Department of Medical and Surgical Sciences, S.Orsola-MalpighiUniversity Hospital, Bologna, Italy; 2Im3D Medical Imaging Lab, Milan,Italy; 3Department of Gastroenterology and Digestive Endoscopy, NuovoRegina Margherita Hospital, Rome, ItalyBackground: Extracorporeal Shock Wave Lithotripsy (ESWL) for difficult commonbile duct stones (CBD) is a safe and effective treatment strategy allowing bile ductclearance in about 90% of patients with a low incidence of mild adverse events. Aimof our study was to compare the CBD clearance rates achieved after ESWL per-formed with two different lithotripters (Siemenes Lithostar Plus and Storz ModulithSLX-F2) in a large cohort of patients with difficult CBD stones. Methods: This is aretrospective analysis of a prospectively collected database. All consecutive patientswho underwent ESWL because of difficult CBD stones between 1990 and 2012 wereconsidered suitable for inclusion. Results: 392 patients with difficult CBD stones

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were treated; 199 patients with Lithostar Plus and 193 patients with Modulith SLX-F2.Common bile duct clearance was achieved in 349 (89.0%) patients with no signifi-cantly difference between the two groups (90.5% vs 87.6%; PZ 0.45). Patientstreated with Modulith SLX-F2 underwent a significantly lower number of ESWLsessions (3.03 � 1.45 vs. 3.54 � 1.88; PZ0.0027), had a lower incidence of ESWL-related adverse events (5.2% vs. 13.6% ;PZ 0.009) and never required opioid anal-gesia (P!0.001). More interestingly, the CBD clearance rate achieved with %3 ESWLsessions, was 51,7% (93/180) when patients were treated with Lithostar Plus and itsignificantly increased to 72,2% (122/169) when Modulith SLX-F2 was used(PZ0.0015). Conclusions: Modulith SLX-F2 allows the same clearance rate of Lith-ostar Plus but with a significantly lower incidence of adverse events and a lowernumber of ESWL sessions.

Su1673Endoscopic Retrograde Cholangiopancreatography (ERCP)Without Using Radiation Is a Safe and Effective Method for theTreatment of Choledocholithiasis During PregnancyGalip Ersoz*, Ilker Turan, Fatih Tekin, Omer a. Ozutemiz, Oktay TekesinDivision of Gastroenterology, Ege University Faculty of Medicine, Izmir,TurkeyBackground & Aim: ERCP has limitations in pregnancy regarding potential risks ofionizing radiation on fetus. To date there have been limited studies of non-radia-tion ERCP during pregnancy. In this study, we aimed (1) To present our experiencein a relevant number of pregnant patients who underwent ERCP without using ofradiation, and (2) To evaluate the safety and efficacy of our ERCP technique inpregnant patients. Methods: A total of 20 pregnant women seen between January2002 and October 2013 who had clinical, laboratory and ultrasonography findings ofhigh probability of choledocholithiasis according to the ASGE 2010 criteria (nZ16)and/or had choledocholithiasis confirmed with MRCP (nZ4) were included into thestudy. All patients underwent ERCP without using radiation by the same endoscopist(GE) who has an experience of more than 10,000 ERCP procedures in our centerwith approximately 500 ERCPs per year. ERCP technique: Biliary cannulation wasachieved by using a double-lumen sphincterotome with a guidewire and wasconfirmed by aspiration of bile, after which a biliary sphincterotomy was performed.In order to facilitate spontaneous passage of residual or further calculi into theduodenum, endoscopic papillary balloon dilation (EPBD) was performed by aballoon dilation catheter according to the diameter of common bile duct (CBD) onUS and/or MRCP; with a gradual inflation up to 6-mm in patients with CBD diameter%7 mm and up to 8-mm in patients with CBD diameter O7 mm. The stones wereextracted by balloon sweeping after dilatation. Biliary stent was not placed in anycases. All patients were followed up for at least 6 months after procedure for thepost-ERCP complications, recurrent choledocholithiasis, and cholangitis. Results:The mean age of patients was 26.5 � 3.7 years, the mean gestational age of the fetuswas 28 � 3.67 weeks. All patients had gallbladder stones ranging from 2 to 5 mmdocumented by US. All patients were effectively cannulated without using fluoros-copy, in 2 patients transpancreatic septotomy was performed for cannulation. EPBDwas performed with a 6-mm balloon in 17 patients, an 8-mm balloon in 3 patients.The stones between 2 to 6 mm were extracted in 16 of 20 patients by balloonsweeping, while no stone was extracted in 4 patients. Two patients had mild post-ERCP pancreatitis and short-term epigastric pain was observed in two patients. Noneof the patients had recurrence of choledocholithiasis and/or cholangitis during the 6months follow-up after ERCP. Conclusion: ERCP can be performed without usingradiation for the treatment of pregnant patients with symptomatic choledocholi-thiasis and cholangitis. The procedure is safe and efficient with minimal risk of re-tained or recurrent stone and post-ERCP complications in experienced tertiarycenters.

Su1674Feasibility of EUS-Directed Biliary Stone Removal WithoutFluoroscopy in Patients With Uncomplicated CholedocholithiasisJanak N. Shah*, Yasser M. Bhat, Chris M. Hamerski, Steve D. Kane,Kenneth BinmoellerInterventional Endoscopy Service, California Pacific Medical Center,San Francisco, CABackground: ERCP inherently involves radiation exposure. In choledocholithiasis,endoscopic ultrasound (EUS) immediately prior to ERCP may allow one to verifythe presence and burden of stones. Biliary access and therapy may then beperformed without fluoroscopy. A few retrospective series have described thisapproach in pregnant patients. We assessed this approach in a series of non-pregnant patients with uncomplicated stone disease. Methods: Consecutive pa-tients referred for suspected biliary stones based on abnormal liver tests,abnormal imaging, and abdominal pain were recruited. Patients with cholangitisor prior sphincterotomy were excluded. Study protocol was as follows: (1) EUS: toverify the presence, size, and number of stones. Patients with O3 stones, largestones (O12mm), intrahepatic or cystic duct stones, or an intra-diverticularpapilla were excluded. (2) Biliary cannulation: Selective biliary cannulation wasattempted using a duodenoscope without fluoroscopy for a maximum 10 min.

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