had a longer LOS (mean 8.1(12.8) vs. 7.8(24.3) dys). After adjusting for confounders withlinear regression analysis, LOS was still related to weekend presentation (beta=0.1, p=0.007).Conclusion In our population-based cohort of AUGIB, there was no increased mortality orrebleeding rate between weekend vs. weekday presentation despite the observed delay toendoscopy at weekends. Weekend presentation was also found to be associated to anincreased LOS. Further studies are required to investigate the potential financial impact ofthese findings.Comparison of patients with a weekday vs. weekend presentation of acute upper gastrointesti-nal bleeding

Data presented as mean (standard deviation) or n (%) as appropriate

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Color Doppler Ultrasound Is Sensitive Nonionizing Technique to EvaluateActive Crohn's DiseaseWataru Shibata, Reiko Kunisaki, Tomohiko Sasaki, Hiroto Kinoshita, Hideaki Kimura, EijiMiyajima, Kazushi Numata, Shin Maeda

Background: Since Crohn's disease (CD) is chronic and multi-focal inflammatory phenotypes,non-ionizing imaging techniques should be considered when evaluating active CD. To avoidthe repeated exposure of radiation caused by computed tomography (CT) or small-bowelfollow-through (SBFT), we assessed the feasibility of using Color Doppler Ultrasound (CDUS)as a standard non-ionizing/non-invasive technique for evaluating the activity of CD, andpredicting the necessity of surgical resection. Methods: Thirty-two histologically proven CDpatients, 88 lesions were enrolled (mean age 31.1 years; disease duration 9.2 years ; meanCrohn's disease activity index (CDAI) 198.2; disease behavior: 9 patients small intestine,24 patients small and large intestine, 23 patients penetrating). The activity of CD was assessedby following variables, including C-reactive protein (CRP), leucocytes and hematocrit andCDAI. We retrospectively evaluated the patients using CDUS, SBFT, and CT before receivingsurgical resection. CDUS findings included the evaluation of intra-intestinal active findingssuch as bowel wall thickness, layer structure, and color Doppler blood flow using Limbergscore. Extra-intestinal findings were also assessed by dichotomous variables, including fis-sures, abscess, adhesion, and pseudo-obstruction. Imaging findings and accuracy values ofCT, SBFT and CDUS were validated by using surgical specimens considered as gold standardreference. Finally, we analyzed the predictive value of CDUS by assessing the necessity ofsurgery for new consecutive 76 patients who underwent medical treatment. Results: Therewas no significant difference regarding the detection rate of active lesions over the threegroups; CDUS, SBFT, and CT for any segment of small intestine. Findings found at thetime of surgical intervention were as follows; stenosis (21 cases), fissure (9), refractory tomedical treatment(9), abscess(1), bleeding(1). Among 88 lesions analyzed, detection rate ofintra-intestinal active lesions determined by CDUS were 62%, and CDUS was significantlyeffective in the detection of extra-intestinal lesions, such as intra-abdominal abscess (CDUS/SBFT/CT; 100%/0%/100%) and intestinal adhesion (CDUS/SBFT/CT; 33%/0%/0%), respec-tively. Among 4 groups based on two parameters (mucosal layer and color blood flow) ofCDUS, the rate of surgical treatment was significantly higher in the group negative for bothmucosal layer and color blood flow (90.1%), when compared to the group positive for both(29.2%). Conclusions: CDUS as a standard non-ionizing technique is more sensitive thanSBFT or CT for evaluation of the affected small bowel lesions in active Crohn's disease.CDUSmay also provide the valuable prediction to determine the need for surgical interventionin patients with irreversible fibrous stenosis that may have caused impaired quality of life.

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Perioperative Administration of Daikenchuto (TJ-100) Reduces thePostoperative Paralytic Ileus in Patients With PancreaticoduodenectomyKen-ichi Okada, Hiroki Yamaue, Masaji Tani, Manabu Kawai, Seiko Hirono, MotokiMiyazawa, Atsushi Shimizu, Yuji Kitahata

Objective: The purpose of this study was to clarify whether perioperative administration ofDaikenchuto (TJ-100) reduce paralytic ileus after pancreaticoduodenectomy (PD). SummaryBackground Data: There has been no literature reporting the management of PD with TJ-100. Methods: Consecutive forty-five patients who had been scheduled to undergo PD atWakayama Medical University Hospital (WMUH) between August 2010 and August 2011were registered in this study including first cohort (n=15) as a control group and subsequentcohort (n=30) as a TJ-100 group. This trial was registered at UMIN-CTR ID# 000005056.

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Results: The postoperative paralytic ileus occurred more frequently in the control group(73.3% of the control group and 20.0% of the TJ-100 group; p=0.001). There was also asignificant difference concerning to the incidence of surgical site infection (46.7% and 6.7%;p=0.003). In postoperative course, the first passages of the flatus and normalization of bowelsounds significantly improved earlier in TJ-100 group than those in control group (p=0.014,0.035). In multiple cytokine assay in the drain fluid and serum, IL-9 and IL-10 in the drainfluid was significantly high level on postoperative day 1 in TJ-100 group. There was nocomplication related with preoperative administration of TJ-100 before surgery, and concern-ing to postoperative Grade1-2 diarrhea (CTCAE4.0) there was no significant differencesbetween two groups. Conclusion: Perioperative administration of TJ-100 was feasible andreduced the paralytic ileus in PD, and further randomized controlled trial should be needed.

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Positive Fecal Immunochemical Test Before Scheduled SurveillanceColonoscopy Was Valuable for the Detection of Interval Cancers - A PilotStudyNozomu Kobayashi, Jun Konishi, Yoshitaka Hirahara, Takahisa Matsuda, Yutaka Saito,Ryuzo Sekiguchi

Background and study aims: Surveillance intervals after colonoscopy are recommended basedon the findings at the baseline examination. In clinical practice, patients have interval fecalblood test and hasten their visit to hospital, but there is no consensus concerning the necessityof front-loaded colonoscopy sooner than the recommended interval. We investigated whetherpositive fecal immunochemical test (FIT) before scheduled surveillance colonoscopy wasvaluable for the detection of interval cancers. Patients and methods: The study included1260 patients who underwent colonoscopy as a result of FIT, and they were divided intothree groups: Group A (n=103), had undergone previous colonoscopy as baseline and thedate of next scheduled surveillance was not yet reached; Group B (n=48), had undergoneprevious colonoscopy as baseline and the date of next scheduled surveillance had passed;and Group C (n=1109), without previous colonoscopy. Ideal surveillance schedules weredetermined according to the guidelines updated by the US multi-society task force oncolorectal cancer in 2012. Advanced adenoma was defined as an adenoma that was 10 mmor more in diameter, a villous adenoma, an adenoma with high-grade dysplasia, or invasivecancer, and the risk of all neoplastic lesion, advanced adenoma and invasive cancer werecompared among three groups. Results: Average age and the rate of male gender were higherin Group B (64.4/49.3 in Group A, 68.6/66.7 in Group B and 63.1/45.1 in Group C; years/%, respectively). In Group A and B, average intervals from previous colonoscopy were 3.73and 9.21 years. The incidence of patients with all neoplastic lesions was significantly lowerin Group A comparing with the other two groups (33.0%, 56.3% and 51.6%, respectively),and Group A showed significantly lower incidence of patients with advanced adenomasthan Group C (8.7%, 16.7% and 19.1%, respectively). In contrast, the incidence of invasivecancer in Group A was lower but not significant (2.9%, 4.2% and 5.0%, respectively). Theage- and sex-adjusted odds ratios for all neoplastic lesion, advanced adenoma and invasivecancer in Group A as compared with Group C were 0.45(95 percent confidence interval,0.29 to 0.69), 0.40 (0.20 to 0.81) and 0.57 (0.17 to 1.85). All of three patients with invasivecancer in Group A had negative findings at baseline colonoscopy and was recommended 10-year interval in theory. Conclusion: Patients with positive FIT before scheduled surveillancecolonoscopy have less neoplastic lesions and advanced adenomas. However, their incidenceof invasive cancer was not negligible, even in patients with negative findings on baselinecolonoscopy. In conclusion, our pilot study suggested that front-loaded colonoscopy as aresult of interval positive FIT was valuable for the detection of interval cancers.

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Improving Outcomes in Severe Pancreatitis With an Acute Care PancreatitisProtocolKristin L. MacArthur, Camilia R. Martin, Tyler M. Berzin, Nathan I. Shapiro, Sunil Sheth,Mandeep Sawhney, Alphonso Brown, Steven D. Freedman

Background: Severe acute pancreatitis is associated with a higher risk of acute renal failureand increased mortality. Early aggressive fluid resuscitation and enteral or parenteral nutritionwithin the first 24 to 72 hours of presentation may be the most important intervention toprevent acute organ failure in severe pancreatitis. However, this is not routinely implementedgiven themultidisciplinary teams involved in these patients.We hypothesized that implemen-tation of a structured management protocol focused on early resuscitation would standardizecare, improve renal function, and decrease length of stay. Objective: Determine the effectof a management protocol on renal function and length of stay in patients with severe acutepancreatitis. Methods: We implemented a protocol beginning September 2011 to be usedby emergency department (ED) and intensive care unit (ICU) physicians at our hospital forpatients with severe acute pancreatitis. The protocol was activated in the ED and consistedof the administration of aggressive crystalloid resuscitation with lab testing every six hours,early nutrition within 24 hours, avoidance of CT scanning, early ERCP if cholangitis waspresent, and a pancreatology consult. We retrospectively identified 41 patients admitted tothe ICU with confirmed severe acute pancreatitis from September 2011 to September 2012.Of these patients, 14 were managed according to the protocol and 37 were managed bythe discretion of their physician (controls). Primary outcomes were creatinine change fromday one to day three and percent of patients with GFR .60 ml/min/1.73m2 on day 3 ofhospitalization. Secondary outcomes included length of stay and mortality. Patient recruit-ment is ongoing, thus only descriptive data are reported. Results: Protocol patients had amean creatinine reduction of 0.38 ± 0.16 mg/dl versus a creatinine reduction of 0.02 ± 0.15mg/dl for the control group over the first three days of admission. By day three, 86% ofprotocol patients compared to 59% of controls had a GFR .60 ml/min/1.73m2 . Lengthof stay was 9.14 days (protocol) compared to 11.3 days (control). No statistical differencewas seen in mortality. There was no statistical difference between protocol patients andcontrols in regards to age, gender, severity (based on BISAP score), or etiology of pancreatitis.Conclusions: Adherence to a strict protocol emphasizing early and aggressive fluid resuscita-tion for patients with severe acute pancreatitis improves renal function and decreases lengthof stay. These results indicate that despite literature demonstrating improved decreased

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