Sa1050

Diagnostic Yield of Endoscopy for Weight Loss: Results of a ComparativeCohort Study vs. Non-Weight Loss ControlsAndrew Ho, Bradley J. Snyder, Poyrung Poysophon, Brennan M. Spiegel

Background: Gastroenterologists are commonly asked to perform pan-endoscopy in patientswith weight loss. This request is based on historical series revealing a high prevalence ofGI causes of involuntary weight loss (Lankisch J Int Med 2001). However, in the absenceof specific GI symptoms or signs, such as bleeding, dysphagia, diarrhea, constipation, oranemia, the yield of endoscopy may be low and its appropriateness unclear. We studiedpatients referred for endoscopy because of weight loss, and evaluated the yield of endoscopyvs. non-weight loss controls. Methods: We performed a retrospective analysis of patientsreferred to the endoscopy unit of a University-based VA medical center from 2000-2010with a primary indication of weight loss. We excluded patients who would otherwise qualifyfor endoscopy regardless of weight loss, such as those with positive fecal occult blood, irondeficiency, previous imaging study with a colonic abnormality, familial GI cancer syndrome,GI bleeding, or prior colon cancer. Although we allowed for diarrhea and constipation, weperformed a sensitivity analysis in which this sub-group was also excluded. We gathereddata on patient characteristics, duration and amount of weight loss, body mass index (BMI),and endoscopy findings. We calculated the proportion of cases in which an explanatoryluminal diagnosis was identified by endoscopy, and compared this to the yield in 2 age andsex-matched control groups: 1) group undergoing screening colonoscopy; and 2) groupundergoing diagnostic colonoscopy for a non-weight loss indication. We conducted separateanalyses for colonoscopy and upper endoscopy (EGD). We employed chi-squared for pair-wise comparisons. Results: There were 95 colons and 61 EGDs identified (mean age=65;93% male; BMI=23). Patients lost a mean of 22 lbs over a 9 month average period. TheFigure reveals the diagnostic yield of the study groups. Two of the 95 colonoscopy patients(2.1%) had primary colon cancer and 3 had colitis as the explanation for weight loss. Thescreening colonoscopy control group resulted in no colon cancers, and the diagnosticcolonoscopy control group revealed 4 cancers (4.2%) and 1 case of colitis (1.1%). Afterexcluding diarrhea and constipation, there was 1 case of colitis (1.8%) and no cancer. Therewere no significant differences among any pair-wise comparisons. Of the EGD cases, therewas 1 gastric cancer (1.6%); the non-weight loss control EGDs revealed 2 gastric cancers(3.3%) (p=NS). Conclusion: In the absence of other GI “red flag” features, patients withweight loss rarely harbor an underlying luminal disease; there is no difference in diagnosticyield of endoscopy vs. age and sex-matched controls. These data suggest that pan-endoscopyfor weight loss is unlikely to be cost-effective in the absence of other concurrent indicationsfor a GI procedure.

Diagnostic Yield of Colonoscopy for Weight Loss vs. Age and Sex-Matched Controls (Groups:A=All weight loss cases combined; B=Weight loss excluding patients with diarrhea orconstipation; C=Controls undergoing screening colonoscopy; D=Controls undergoing dia-gnostic colonoscopy for a non-weight loss indication). All pair-wise comparisons werenon-significant.

Sa1051

A Prospective, Multicenter, Blinded Cohort Study Comparing CapsuleEndoscopy (CE) vs. Small Bowel Follow Through (SBFT) vs. Ileocolonoscopy(IC) in Diagnosing Small Bowel (SB) Crohn's Disease (CD) and Impact onPatient ManagementJonathan A. Leighton, Stanley A. Cohen, Ervin Toth, David R. Cave, Douglas C. Wolf,Gerard E. Mullin, Scott R. Ketover, Peter Legnani, Ernest G. Seidman, Ian M. Gralnek,Rami Eliakim

Background: CD is a chronic, inflammatory disorder affecting the gastrointestinal tract.Traditionally, the diagnostic evaluation of suspected CD involves IC and radiology. AlthoughIC is the community standard for diagnosis, SBFT is still commonly used despite pooraccuracy and potential for delaying diagnosis. CE appears to be sensitive for the detectionof SB mucosal lesions when other tests are negative. However, the impact of CE on patientmanagement in CD involving the SB is lacking. Aim: The primary objective of this studywas to evaluate whether CE prior to IC impacts disease management. Methods: Subjectsaged 10-65 years who presented with suspected SB CD were enrolled. Suspected CD wasa priori defined as abdominal pain and/or diarrhea for more than 6 weeks plus alarm features(elevated ESR or CRP, anemia, hypoalbuminemia, positive CD serology or abnormal WBCscan). Subjects first underwent CE, followed by SBFT and IC, the order determined byinvestigators. Test results were reviewed blindly. Impact on patient management was assessed

S-213 AGA Abstracts

by physician survey, measuring therapeutic decisions based on each diagnostic modality:initiate or change medications, refer/not refer for surgical evaluation, perform/ not performadditional endoscopic exams, initiate diet supplements, perform/not perform complementaryprocedure. Results: 74 patients (mean age 28.6) underwent CE, 73/74 underwent IC, and70/74 underwent SBFT. 27% (20/74) subjects were diagnosed with SB CD based on CEfindings. The physicians reported that CE altered disease management in 24/74 (32%) ofthe patients, 88% of them due to a change in medications; IC altered disease managementin 17/73 (23%) of the patients, 88% of them led to a change in medications; SBFT altereddisease management in 10/70 (14%) of the patients, 20% of them due to a change inmedications. There was no statistically significant difference between CE and IC in alteringpatient management (p= 0.268). Conclusions: 27% of subjects had SB CD by CE. This yieldsupports the relevance of CE in evaluating patients with abdominal pain and/or diarrhea +alarm features. There was a trend for CE to impact patient management more frequentlycompared to IC and SBFT. In patients whose capsule study altered disease management,88% were due to a change in pharmacological management. Additional studies are warrantedto confirm these findings.

Sa1052

Quality of Pathology Specimens From Sessile Colon Polyps Obtained Withand Without Submucosal Saline InjectionDaniel Shats, Adam B. Elfant, Jeanette M. Camacho, Thomas A. Judge, Steven R. Peikin

Introduction: Submucosal injection of various substances (saline, epinephrine, methyleneblue) below a polyp has been advocated by some endoscopists to reduce the likelihood ofcolonic perforation, postpolypectomy bleeding or residual polyp. Whether polypectomyperformed after submucosal injection yields a better specimen for pathologic analysis has notbeen investigated. Objective: To compare the diagnostic quality of polypectomy specimensobtained with and without injection of submucosal saline. We hypothesize that polypsremoved after the injection of submucosal saline will exhibit less cautery damage, morecomplete removal and enhanced diagnostic quality. Methods: Patients found to have a sessilepolyp at least 7 mm in diameter during colonoscopy underwent polypectomy as per routinepractice. The choice of polypectomy technique was left to the discretion of the endoscopistand only polyps resected en bloc were considered. Twenty specimens obtained by hot snarepolypectomy with submucosal saline injection and twenty specimens obtained by hot snarepolypectomy without saline injection were collected. Polyp diameter was recorded. A single,experienced gastrointestinal pathologist blinded to polypectomy technique rated each speci-men on the following dimensions: amount of cautery damage (mild, moderate, marked),degree of cautery damage (none, mild, moderate, extensive, unreadable), preservation ofcellular architecture (good, fair, poor), polyp margin evaluability (yes, no), overall diagnosticquality (good, poor). Results: Using independent samples t-tests for means and the Fisherexact test for proportions, no significant differences in quality of pathology specimenswere observed between polypectomy techniques across all studied dimensions. Within eachpolypectomy technique, amount of cautery damage was rated as moderate or marked in15% of specimens, cellular architecture was rated as good in at least 90% of specimens,and diagnostic quality was described as good for at least 95% of specimens. Polyp diameterdid not differ significantly between polypectomy techniques. Conclusion: While saline-assisted polypectomy may be helpful for improving other outcomes, the injection of submuco-sal saline prior to resection of sessile polyps does not yield a higher quality specimen forpathologic interpretation.

Sa1053

Invasive Colorectal Cancer Within 5 Years of Negative Colonoscopy atJapanese Rural HospitalAkira Horiuchi, Yoshiko Nakayama

BACKGROUND AND AIMS: Colonoscopy has been used as the gold-standard diagnostictest for colorectal cancer (CRC) screening, but the detection may fail, and the reasons forthis are not completely understood. The present study attempted to examine the clinicalfeatures of invasive CRC detected after a negative colonoscopy for cancer. METHODS: 10,148subjects whose colonoscopic examinations were performed for 5 years between January2005 and December 2009 at a single rural hospital in Japan were retrospectively examinedwith regard to indication, endoscopic findings, previous endosocopic findings, and clinicalfeatures of patients with invasive CRC. RESULTS: In a 5 year period 202 subjects withoutthe previous colonoscopy were diagnosed with invasive CRC. On the other hand, 3,212(32%)of 10,148 subjects underwent previous colonoscopy within 5 years because of positive fecalblood test, abdominal symptoms, and hematochezia. Of 3,212 subjects 9 invasive cancerswere detected within 5 years after a negative colonoscopy for cancer. The ratio of invasiveCRC detected with / without previous colonoscopy was 0.017(1/60) in the rectum, 0.019(1/54) in the sigmoid colon, 0.067(1/15) in the descending colon, 0 (0/28) in the transversecolon, 0.16(5/31) in the ascending colon, 0.71(1/14) in the cecum, and the ratios in theascending colon and in the cecum were markedly higher than those in other portions. Fiveof 6 patients with invasive CRC in the ascending colon and cecum had small adenomas inthe ascending colon at the previous colonoscopy. CONCLUSIONS: The majority of invasiveCRC detected within 5 years of negative colonoscopy ocurred in patients who had smalladenomas in the ascending colon at previous colonoscopy. Therefore, the development ofthe method for detecting small or flat lesions in the ascending colon completely may reduceinvasive CRC within 5 years of negative colonoscopy. The surveillance for those with right-sided adenomas may need to be at a shorter interval.

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