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he procedure. Very few downstream procedures resulted from wireless capsulendoscopy and did so at a net loss in profit. This has financial implications forny medical center that is currently operating or considering undertaking a smallowel directed endoscopy program.

1525ariations in the Process of Care Among Patients Withonvariceal Upper GI Hemorrhageasiha Kanwal, Sara Echelmeyer, Nabeel Koro, Timothy Chrusciel,rennan M. Spiegelackground: With an increasing emphasis on quality in health care, it is critical

o understand the current process of care for common conditions, such asonvariceal upper GI hemorrhage (NVUGIH). A 9-member multidisciplinaryxpert panel recently used the standardized modified Delphi approach todentify a set of explicit quality indicators (QIs) for NVUGIH (DDW 2009). As itsrst application, we measured the degree of adherence to this QI set in aetrospective NVUGIH cohort. Methods: Using a standardized chart abstractionool, we abstracted data from electronic medical records of 230 patients withVUGIH at one large VA medical center from 2000-2008. Prior to data collection,e created a detailed conceptual model to delineate variables that would alloweasurement of the QIs. Using these data, we assessed the quality of NVUGIH

are as measured by 26 QIs targeting 3 domains: pre-EGD (n�9 QIs), intra-EGDn�11 QIs), and post-EGD care (n�6 QIs). Content coverage included diagnosis,arly resuscitation, risk stratification, EGD care, H. pylori management, & PPIherapy. For each patient, we derived overall and domain specific quality scoresalculated as the percentage of indicated QIs received. Results: There was wideariation in the individual QI rates as shown in the Table. Overall, patientseceived 54% of recommended pre-EGD care, 32% of intra-EGD care, and 51%f post-EGD QIs. Adherence was highest for diagnostic and resuscitation QIs,hereas adherence was lowest for endoscopic management QIs. Conclusions:ur data reveal wide variations in the process of care for patients with NVUGIH.he quality of pre- and post-EGD care was superior to intra-EGD care. Althoughhese data are limited to a single center, the degree of variations in the rates forifferent QIs indicate that even within a single facility physicians use differenteuristics in deciding which processes to employ. Future research shoulddentify modifiable drivers of process variation. In the meantime, these pilot dataighlight the need to systemize care in order to reduce unwarranted variations.GD-specific care processes may serve as a high yield target for these initialuality improvement efforts.

dherence Rates of Selected Quality Indicators

Selected Quality Indicators%

Adherence

mong patients with endoscopy, % with documentation ofhemostasis

100

mong patients with hypoxemia, % who received supplementaloxygen

97

mong patients with H pylori infection, % who receivedantibiotics

79

mong patients with successful hemostasis, % who received �48 hours of PPI infusion

56

mong patients with normal vital signs, % with documentedorthostatics

38

mong patients with NVUGIH, % who received EGD within 24hours

23

mong patients with NVUGIH, % with documentation of riskstratification

12

1526urvey on the Value of Capsule Endoscopy in Clinical Practice:he Referring Gastroenterologist’s Perspectivelorin Costea, Ernest G. Seidmanntroduction: Capsule endoscopy (CE) is recognized as a significant technologicdvancement in gastrointestinal endoscopy that provides noninvasive, high-esolution imaging of the small bowel. Accepted as the gold standard instablishing the diagnosis in obscure gastro-intestinal bleeding (OGIB) anduspected Crohn’s disease (CD). Aim: Evaluate gastroenterologists’ (GI)erspective on the value of CE in clinical practice. Methods: 88 referring GIsithin the province OF Quebec received a questionnaire requesting follow upata on 200 consecutive patients who underwent a CE in 2007-8, and followedp for at least 1 year. Indications for CE were: OGIB and/or iron deficiencynemia (IDA) (n�147), suspected CD (n�37) and other indications such asuspected celiac disease, lymphangiectasia, malabsorption (n�13). Theuestionnaire focused on the GI’s perspective of the value of CE as a diagnosticool, including accuracy, avoidance of additional testing, as well as its impact on

linical outcome and treatment modifications.Results: Responses were receivedrom 52/88 GIs (59%) in various types of practice settings (31 tertiary hospitals,

ww.giejournal.org Volu

11 community hospitals, 10 community based practitioners). Data were availablefor 98/200 patients, 80 adults (47 F, 33 M, mean age 57; range: 18-91) and 18pediatric cases (10 M, 8 F, mean age 11; range: 6 to 17). Patients had previouslyundergone at least one negative upper and lower endoscopy. 24% of respondingGI’s rated the CE investigation indispensable to the diagnosis, 30% rated it asuseful, while another 37% found it useful for the differential diagnosis. Only 9%of respondents found it non contributory. Diagnostic accuracy of the CE wasconfirmed in 97% of 98 cases with positive findings, including 135/147 (92%)with OGIB/IDA and 36/37 (97%) of suspected CD. A 3% failure rate in diagnosiswas reported in 3 OGIB patients: 1 missed duodenal GIST diagnosed intra-operatively, 2 cases with missed jejunal polyps diagnosed by double balloonendoscopy. Follow up of the studied patients reported 35% improved clinicallyand another 37% were reassured after the CE. In 44 % of cases, the GIs reportedthat disease management was altered by CE, with 12% referred for surgery. Thereferring GI’s qualitative evaluation of global satisfaction with CE was positive in97% and negative in 3%.Conclusions: This study illustrates the clinical value ofCE to referring GIs. After negative evaluations for OGIB or suspected CD, CEwas deemed to have an impact on diagnosis, affect clinical outcomes as well asavoid unnecessary additional investigations, improving the timing and accuracyof diagnosis of small bowel disorders.

M1527Prediction of Barrett’s Esophagus (BE) in Patients WithGastroesophageal Reflux Disease (GERD) Using LogisticRegression Model (LRM) and Artificial Neural Network (ANN)Srinivas Gaddam, Amit Rastogi, Neil Gupta, Sachin B. Wani,Ajay Bansal, Mandeep Singh, Vikas Singh, Savio Reddymasu,Brian Moloney, Prateek SharmaBackground: Identification of high risk group for BE using clinical anddemographic factors may help in risk stratification of pts for endoscopy. Aim: Inpatients with chronic GERD -to identify risk factors for BE -to generate a modelusing LRM and ANN to predict presence/absence of BE.Methods: Consecutive ptsundergoing index endoscopy for evaluation of GERD symptoms were asked tocomplete a validated GERD questionnaire (GERQ) in this prospective study.Demographics, medication history, and EGD findings were recorded. Univariateanalysis was performed using chi-square and Mann-Whitney U test to comparedifferences among patients with and without BE. Variables with a significance of0.1 or less were used to create a LRM to predict BE. Using the same data, asupervised feed forward ANN - multilayer perceptron (MLP) using SPSS NeuralNetworks (SPSS Inc., Chicago, USA), was trained to build a prediction model.Overtraining was prevented by cross verification during training. Receiveroperating characteristic (ROC) curves were used to compare the performance ofthe models. Results: Of 979 total GERD patients, 93.3% were males, 83% wereCaucasians, mean age (SD) 57.42 (12.7), and mean BMI 29.6 (5.6). BE wasdiagnosed in 140 (14.4%). On univariate analysis, the significant factors for thepresence of BE were BMI, Caucasian race, severe heartburn (HB), HBduration � 5 years, regurgitation duration � 5 years, age � 60, and smoking.The prediction equation was Y � (-0.054*BMI) � (0.764*smoking) �(0.974*Caucasian) � (0.619*severe HB) � (0.803*Regurgitation �5 years) - 2.405.ROC curve demonstrated that using cut-off value at 0.077, the Se was 90% andSp was 30% with an AUC � 0.673. After multiple ANN models were trainedusing MLP with back propagation, the best model was obtained by heuristicexperimentation with an AUC � 0.684.Conclusion: Linear and non-linearstatistical methodologies were tested to generate a prediction model for BE usinga well-developed prospective database and both showed similar accuracy. In thiscohort of GERD patients, our LRM had a high sensitivity but low specificity forpredicting BE and requires external validation. The use of additional factors (eg:serum biomarkers) in conjunction with clinical characteristics will be required toimprove the accuracy in prediction of BE.

Predictors of BE

Risk Factors OR (95% CI) p-value

BMI 0.946 (0.90 - 0.99) 0.019Caucasian race 2.640 (1.10 - 6.31) 0.029Severe HB 1.913 (1.25 - 3.33) 0.01RG duration � 5 yrs 2.035 (1.25 - 3.33) 0.005Current or past smoker 2.070 (1.02 - 4.19) 0.043

M1528Colorectal Cancer Screening in African Americans 45-49 YearsOldAbhinav Sankineni, Frank K. FriedenbergIntroduction: The American College of Gastroenterology (Am J Gastro 2009,104:739-750) recommends colorectal cancer (CRC) screening for average risk African

Americans at age 45-49 (Grade 2C recommendation). This is based onepidemiologic data suggesting a younger age for the development of polyps and

me 71, No. 5 : 2010 GASTROINTESTINAL ENDOSCOPY AB245