*4482USEFULNESS OF POLYMERASE CHAIN REACTION FOR THEDIFFERENTIAL DIAGNOSIS OF INTESTINAL TUBERCULOSISAND CROHN’S DISEASE.Kwang Ro Joo, Suk-Kyun Yang, Seung Jae Myung, Gyeong Hoon Kang, JaeWon Choe, Eui-Ryun Park, Ki Nam Shim, Do Ha Kim, Hwoon-Yong Jung,Weon-Seon Hong, Young Il Min, Univ of Ulsan Coll of Medicine, Asan MedCtr, Seoul, South Korea.Background & Aim: The definite diagnosis of intestinal tuberculosis (I-TB)is made by histological evidence of caseating granulomas or acid-fast bacil-li, or growth of M. tuberculosis on culture of biopsy specimens. It is oftendifficult, however, to differentiate I-TB from Crohn’s disease (CD) when allof the three tests were negative. The aim of this study was to evaluate theusefulness of M. tuberculosis complex-polymerase chain reaction (TBC-PCR) for the differential diagnosis of I-TB and CD. Methods: We obtainedbiopsy specimens from 32 patients with I-TB and 29 patients with CD.Ziehl-Neelsen stain, M. tuberculosis culture and TBC-PCR were carriedout in all patients. TBC-PCR was also performed with normal colonic spec-imens obtained from 22 patients with colonic polyps as the control. TBC-PCR was done with DNA extracted from the paraffin-embedded tissues inall cases. Four pairs of oligonucleotide primers (Bioneer, Korea) were usedfor the nested PCR at the two different sites of IS6110 insertion elementof M. tuberculosis complex. Results: The TBC-PCR gave positive results in23 (72%) of 32 patients with I-TB, 3 (10%) of 29 patients with CD, and 3(14%) of 22 normal controls, yielding a sensitivity of the TBC-PCR on biop-sy specimens of 72% and a specificity of 88%. In patients with I-TB, thesensitivity of culture, acid-fast bacilli stain and caseating granulomas were44%, 25% and 9%, respectively. When all of these three tests were com-bined, the sensitivity rose to 63%. In addition, among the 12 I-TB patientswith the negative result in all of the three conventional tests, 8 (67%) werePCR-positive. Therefore when the result of TBC-PCR was combined withthat of histological examination and culture, the sensitivity became high-er upto 88%. The positive rate of TBC-PCR was 100% in patients showingcaseating granulomas or acid-fast bacilli on histological examination, and64% in culture-positive patients. Conclusions: TBC-PCR is a very sensitivemethod for the diagnosis of I-TB. Therefore, combining of TBC-PCR withconventional methods might be helpful in differentiating I-TB from CD.

*4483ARGON PLASMA COAGULATION IS AN EFFECTIVE AND WELLTOLERATED TREATMENT FOR RECTAL BLEEDING DUE TOCHRONIC RADIATION PROCTITIS.Mehdi Kaassis, Frederic Oberti, Pascal Burtin, Jean Boyer, Univ Hosp,Angers, France; Inversity Hosp, Angers, France.The treatment of rectal bleeding due to radiation proctitis is difficult tomanage. Argon Plasma Coagulation (APC) is a technique of electrocoagu-lation which appears to be an effective and low-cost alternative to lasertherapy. Aims. Our aim was to evaluate the efficacy and tolerance of APCfor treatment of bleeding radiation-induced proctitis. Patients. We retro-spectively analyzed the charts of 16 patients with chronic radiation procti-tis. The mean age was 73.5 years (range: 62-80). Primary tumor was a pro-static cancer (No=15) and a uterine cancer (No=1). The mean time of onsetof symptoms after radiotherapy was 15 months (range: 6-36). All patientscomplained of intermittent or daily rectal bleeding, of whom 3 neededblood transfusions. After a first colonoscopic evaluation, the patientsunderwent APC therapy at 1 month intervals. Argon gas flow was set at0.6 L/min with an electrical power of 40 Watts. Results. All patients wereimproved by APC and a mean of 3.7 sessions (range: 2-8) was necessary forsymptoms relief. During a mean follow-up of 7 months (range: 2-21months), rectal bleeding did not recur in 7 patients (43.7%); in the other 9patients (56.3%), bleeding was significantly reduced to occasional and neg-ligible spotting (1 bleeding episode per week). No patient required trans-fusion after treatment. Immediate tolerance was good and no long-termtreatment-related complication was observed. Conclusions. APC is aneffective, safe and well tolerated treatment for rectal bleeding due tochronic radiation proctitis and might be considered as a first-line therapyfor radiation proctitis.

*4484COLONOSCOPIC FINDINGS IN INTESTINAL BEHCET’SDISEASE.Won Ho Kim, Chung Ryul Lee, Yong Suk Cho, Jeong Youp Park, MyungWhan Kim, In Suh Park, Yonsei Univ Coll of Medicine, Seoul, South Korea.Background: Behcet’s disease is a multisystemic chronic inflammatory dis-ease characterized by oral ulcer, genital ulcer, skin manifestations and ocu-lar involvements as major symptoms. Minor symtoms include arthritis orarthralgia, vascular lesion, CNS involvement, epididymitis, and intestinalulcers. Intestinal involvement in Behcet’s disease is not rare in Korea.Ulceration can occur in any part of the gastrointestinal tract including theesophagus, stomach and duodenum, but the ileo-cecal area is the mostcommonly involved site. Aim: The aim of this study was to characterize thecolonoscopic findings of intestinal Behcet’s disease. Methods: We retro-spectively reviewed colonoscopic examinations in 92 patients with intesti-nal Behcet’s disease. Among 92 patients, complete, incomplete, suspicious,and possible types included 16, 26, 24, and 18 cases, respectively. Theremaining 8 cases did not have any major systemic manifestation ofBehcet’s disease. About 2/3 of the patients were diagnosed as Behcet’s dis-ease before intestinal involvement was identified. Twenty-four (26%)patients had a previous history of intestinal resection at the time of colo-noscopy. Results: Abdominal pain (94%) was the most common symptom,followed by diarrhea (30%), melena/hematochezia (25%), weight loss, fever,indigestion and nausea/ vomiting. Colonoscopy demonstrated ulcerativelesions in all cases. Among patients who did not have operations, ileo-cecalarea was the most commonly involved site (92%). Seven (8%) patients hadulcers in other parts of the colon. All of the operated patients had ulcers atthe ileo-colonic anastomostic site. Most (95%) of the ulcers were round/ovalor geographic in shape while longitudinal or circumferential ulcers wererare (5%). Sixty-one patients (66%) had a single ulcer, 19 (21%) had sever-al (2-5) ulcers, and 12 (13%) had multiple (≥6) ulcers. The ulcer was small(≤ 10 mm) in 20 patients (22%), medium-sized (11-20 mm) in 20 (22%), andlarge (> 20 mm) in 52 patients (57%). Mean size of ulcer was 3.0 cm. Theulcer was deep in 56 patients (61%) while shallow in 36 (39%). The marginof ulcer was discrete in 75 cases (82%), elevated and nodular in 56 cases(62%), and erythematous in 48 cases (52%). Mucosal changes adjacent tothe ulceration such as erhthema and edema were not common, and werenoted in 22 cases (24%). Conclusion: Typical colonoscopic finding in intesti-nal Behcet’s disease included a single or a few deep ulcers with discretemargin and normal adjacent mucosa in the ileocecal area or ileo-colonicanastomotic site.

*4485INCIDENCE OF DEPRESSED COLORECTAL NEOPLASIA INSOUTHERN BRAZIL.Claudio Rolim Teixeira, Jorge Muller Griebeler, Eunice BernardesTonelotto, Nelson Vieira Coelho, Ronaldo Spinatto Torresini, Carlos Saul,Anis Kurban, Reinaldo Balduino Petter, Fugast, Porto Alegre, Brazil.Flat and depressed colorectal lesions despite being increasingly reportedin Japan, are still a matter of controversy in western countries and thetrue incidence of these lesions is poorly undestood. The AIM of this studyis to evaluate the incidence of depressed lesions diagnosed on routine colo-noscopy in a brazilian endoscopic center. METHODS During January 1996to May 1999, all total colonoscopies performed with magnifying colono-scope(Fujinon410CM) allowing up to 40x magnification of the standardvideoimage, were included in the analysis. Patients with familial polyposisand inflammatory bowel disease were excluded. Macroscopically, colorectalneoplastic lesions were classified as polyps, flat elevated lesions, depressedlesions(IIc) and lateral spreading tumors. On colonoscopy the lesions wereexamined in detail by chromoscopy with indigo-carmine 2% and/or pyok-tanin-blue 0.5% and the pit pattern on the surface of the lesion was deter-mined as Kudo’s classification. All lesions were resected by polypectomy orendoscopic mucosal resection (EMR). RESULTS Among 1930 total colono-scopies, 13 depressed lesions (0.7%) were diagnosed. Size of the lesions var-ied from 1.4 to 7mm in diameter. Seven lesions were located in the sigmoid,3 in ascending, 2 in the transverse and 1 in the descending colon.Histologic diagnosis was carcinoma in 6 lesions, adenoma with high-gradedysplasia in 5 lesions and low grade in 2 lesions. Pit pattern of thedepressed lesions were IIIs in 9 lesions, V in 3 lesions and IV in one lesion.Other diagnosed lesions in this group of patients were 1594 polyps, 63 flatelevated lesions and 51 lateral spreading tumors. CONCLUSIONSDepressed colorectal neoplasia exhibiting the same features as reported byjapanese investigators were also diagnosed in our group of patients.Despite the small size and low incidence (0.7%) of depressed lesions, thehigh frequency of carcinoma and high-grade dysplasia diagnosed in theselesions emphasize the need for the endoscopic diagnosis and resection ofthese lesions to prevent colorectal cancer.

VOLUME 51, NO. 4, PART 2, 2000 GASTROINTESTINAL ENDOSCOPY AB147