decline in the mean platelet count, which failed to improve on discontin-uation of Ribavirin.

389

Acute liver failure due to mushroom poisoning: a clinical series.Guilherme Macedo, MD, FACG, Jose´ Costa Maia, MD, Abilio Gomes,MD, Susana Lopes, MD, Fa´tima Carneiro, Ph.D., Ana Mota, MD,Araujo Teixeira, Ph.D., Tome´ Ribeiro, Ph.D. Gastroenterology andLiver Transplant Unit, H.S. Joa˜o, Porto, Portugal.

Mushroom poisoning, mycetismus, is a well recognized medical emer-gency, that may lead to fulminant hepatic failure, with significant mortality,specially if associated with renal failure and cerebral lesions. Timing forliver transplantation is particularly difficult in this setting because progres-sive organ damage may evolve unrecognized and rapidly. Two groups oftoxins induce different symptoms, in a sequential form: phalloidin, at first,which would be responsible for gastrointestinal upset; alpha-amanitin af-terwards inducing subclinical deterioration, and acute liver failure (ALF),with encephalopathy and bleeding diathesis. We present 3 cases of ALFdue to Amanita Phalloides ingestion, with different clinical courses, inwhom timing for transplantation was evaluated and eventually performed.These were 2 men (aged 28 and 66) and a 38 years old caucasian woman,from 3 nonrelated families, that were admitted in different seasons, afterconsuming wild mushrooms with other family members, who had transientgastrointestinal symptoms. We describe the clinical evolution, time lagbetween ingestion and ALF, blood chemistries, Clichy’s and King’s Col-lege criteria for liver transplant and treatment. To patients progressed tograde 3 encephalopathy and were proposed for urgent liver transplant,successfully performed in one, and not done in the older patient, who diedafter 72 h in a national urgent waiting list. The younger patient had anuneventful total recovery after intensive care. We conclude that mushroompoisoning may have a fatal outcome, that clinical evolution may be vari-able, and that intensive therapy should be proposed in an institution able toperform liver transplantation.

COLON

390

Endoscopic argon plasma coagulation (APC) for radiationproctopathyKW Adkisson, MD, Stanley J Rogers, MD, John P Cello, MD.Departments of Medicine and Surgery, San Francisco General Hospitaland the University of California, San Francisco.

Radiation therapy for pelvic neoplasia is widely employed for both curativeand palliative intent. Although safe and effective, 5–10% patients experi-ence the undesirable complication of radiation proctitis (more properlycalled proctopathy). The rectal bleeding is typically intermittent but rarelypresents as acute lower GI bleeding. Endoscopic evaluation reveals scat-tered vascular ectasias throughout the rectum/distal sigmoid. The vascularectasias are felt to arise from neoangiogenesis resultant from vascular wallfibrosis induced by radiation. Many modalities for treatment have beenemployed including topical application of various agents (formaldehyde,short-chain fatty acids, sulfasalazine, 5-ASA), endoscopic use of Nd:YAGlaser, bipolar cautery and various surgical interventions. APC is a newendoscopic coagulation modality employing pressurized ionized argon gasdelivered via polyethylene catheter to achieve superficial cauterization.Five patients diagnosed with symptomatic radiation proctopathy and ane-mia underwent APC at our institution within the past 18 months. Onepatient had been treated previously with YAG laser. During each endo-scopic treatment session a flexible sigmoidoscopy was performed followedby ablation of rectal ectasias by APC. Routine APC application consistedof multiple, brief pulses from the APC device (ERBE) set at 60–65 wattsapplied by mucosal “painting” over focal areas of visible ectasias. Patientsreceived a mean of 4.6 (range 2–7) treatment sessions (approx. one session

every 3 wks). Hematocrit (Hct) values immediately preceding APC therapyand packed red blood cell transfusions (PRBC) during a 6 month intervalprior to APC were compared to Hct and PRBC requirements during APCtherapy. Hct values remained stable or improved while the need for PRBCwas either eliminated or substantially decreased in all patients. Statisticalsignificance was not achieved due to the limited sample size. All patientstolerated the procedure well with no complications noted.Conclusion: APC is a reliable and acceptable endoscopic treatment optionfor ectasias associated with radiation proctopathy and may be superior toother forms of coagulation therapy in ablating vascular ectasias.

391

Side-viewing colonoscopy for the evaluation and treatment ofdifficult colonic lesions.Aziz Ahmad, MD, Paul S Berg, MD, Matthew McKinley, MD, FACG.North Shore University Hospital, Manhasset, NY and ProHEALTH CareAssociates, Lake success, NY.

Objective: To investigate the use of side-viewing technology in colonos-copy.Background: Endoscopy has transformed and improved our approach todigestive diseases. Despite great advances, there are technical limitations tocurrently available endoscopes. Studies examining the inherent polyp missrate of colonoscopy, using methodology such as same day repeat exams,often site the angle of visualization as a limiting factor. This is particularlyproblematic in lesions located on the proximal aspects of valves or haus-trae. It is for this reason that wide-angle colonoscopy is being investigated.Until such technology is perfected, endoscopists need to utilize all availabletools. We describe the role of the side-viewing enterscope in the evaluationand treatment of three difficult colonic lesions.Methods and Results:Three cases of colonic neoplasia were addressedwith the standard forward viewing technique. Anatomic parameters limitedvisualization and attempts at therapy. Two lesions were on the proximalaspect of folds (rectum and sigmoid) and one in the splenic flexure. Aside-viewing enteroscope (Olympus TJF-130) was gently introduced bycarefully extending the scope tip and then advancing in small “blind”movements in a neutral tip position. Using this technique, improved visu-alization was easily achieved. Polypectomy and biopsy was technicallypossible only with the side-viewing instrument in these patients. Thepresence of an elevator on the enteroscope assisted manipulation of acces-sories.Conclusion: In the hands of endoscopists familiar and comfortable with theside-viewing enteroscope, it can be a useful tool in the evaluation andtreatment of colonic lesions not amenable to standard therapy. Benefits willneed to be compared to any increased risks, especially in patients withanatomic conditions such as diverticulosis.

392

Rectal resection and coloanal anastamosis: a retrospective studyRobert Akbari, MD, Philip F Caushaj, MD, FACG*, Devora EHathaway, RN, William McDougall, MD. The Western PennsylvaniaHospital, Pittsburgh, Pennsylvania, United States

Purpose: Surgical treatment of rectal carcinoma has changed over theyears. The abdominoperineal resection (APR) is the gold standard. Morerecently sphincter preservation via coloanal anastamosis has gained pop-ularity. This retrospective study was done by reviewing one surgeon’sresults with coloanal anastamosis in order to reiterate the benefits of thisnewer operation.Methods: In a retrospective fashion, all rectal resections and coloanalanastamosis done by one surgeon between 1986 to 1999 were analyzed.This included 38 patients. Various surgical indications included rectaladenocarcinoma (23), villous adenoma (5), Hartman/Diverticulitis (5),proctitis (2), and miscellaneous (3). Various preoperative studies wereused. Most patients with adenocarcinoma had either T2 or T3 lesions by

2525AJG – September, 2000 Abstracts