M1365

Characteristics of Metachronous Multiple Early Gastric Cancers

After Endoscopic Mucosal ResectionSeung Hoon Baek, Joo Young Cho, Hae Jung Song, Soo Hoon Eun,Young Dae Kim, in Seop Jung, Chang Byum Ryu, Young Deok Cho, JinOh Kim, Joon Seong Lee, So Young Jin, Moon Sung Lee, Chan Sup Shim,Boo Sung KimBacground/Aims: Early gastric cancer (EGC) has occasionally been discovered to beassociated with a secondary EGC. Therefore, the entire stomach must beconsidered a potential source of malignant disease. Since endoscopic treatment hasbecome established as treatment for EGC, it has become a major problem. Weperfomed this study to define the clinical and pathological features of multiplegastric cancers in contradistinction to those of single gastric cancer. Methods: From1998 to 2005, 389 cases of EGC underwent EMR were evaluated. We defined theincidence and characteristics of synchronous multiple lesions or metachronousrecurrence after EMR. The factors for predicting multiple lesions was evaluated bylogistic regression model. Results: Mean age at diagnosis was 62 years (range25-89), and the mean period of endoscopic follow-up was 18 months (range 2-96months). Multiple EGC was detected in 30 patients (7.7%). 27 patients hadsynchronous double EGC involving 58 foci within 1 year of the initial EMR. 82% ofsynchronous double EGC were diagnosed at initial examination simultaneously. 3patients had metachronous recurrence involving 6 foci, whose the period prior todetection was 53 to 88 months (mean 78.3 months). In the 80.0% multiple cases,accessory lesions were located in a different portion of the stomach from primarylesions. The relative locations of the accessory lesion were proximal to the mainlesion in 43.3% of the cases, parallel in 36.7%, and distal in 20.0% in multiple EGC.Multiple EGC occurred more frequently in older patients (p Z 0.001). Elevatedlesions were found more frequently in multiple EGC (p Z 0.001). There was nosignificant difference in gender, histology, location of lesion, H pylori infection andoverexpression of p53 protein between multiple and single EGC. Conclusions: Theexistence of multiple gastric cancer should be considered before, and after EMR. Weclarify that elderly patients and elevated lesion are at a high probability for multipleEGC. Meticulous attention should be exercised so as not to leave a secondary lesionin the residual stomach, especially in old age whose endoscopic appearance iselevation. Key Words; Endoscopic mucosal resection, Early gastric cancer,Synchronous multiple lesions, Metachronous recurrence.

M1366

Palliation of Patients with Malignant Gastric Outlet Obstruction

with Newly Designed D-Type StentIruru Maetani, Masahiro Seike, Masaki Ikeda, Tomoko Tada, Takeo UkitaBackground and study Aim: Gastric outlet obstruction is usually occurred as a latecomplication of advanced gastric cancer and periampullary malignancies. Palliationof symptoms of obstruction is the primary aim of treatment in these patients.Recent reports have described stent placement as a desirable alternative toconventional bypass surgery which is associated with significant risks of morbidityand mortality. Although stent placement for pyloroduodenal obstruction isrelatively difficult, through-the-scope (TTS) stents facilitate the procedure.However, most braided TTS stent has some drawbacks, such as relatively frequentmigration and significant foreshortening. A newly designed TTS stent which isweaved out of FYI nitinol (D-type pyloric stent, Taewoong Medical Co.) has beendeveloped to overcome these problems. We analyzed our clinical experience withthe stent. Methods:In 8 patients (6 men, mean age 73 years) with symptomaticmalignant pyloroduodenal obstruction, 10 stents (D-type stent; 20 mm in diameter,80 or 100 mm in length) were endoscopically placed with TTS placementprocedure. Obstruction was caused by following unresectable cancers: gastriccancer in 5, metastasis in 2, and pancreatic cancer in 1. All patients had nausea,vomiting or inability to eat. Four all patients with concomitant biliary obstructionunderwent placement of biliary metallic stent (endoscopic, 3; percutaneous, 1)prior to pyloroduodenal stenting. We analyzed clinical outcome in these patients.Results: Stents were successfully placed in all patients. An average procedure timewas 24.3 minutes. With the exception of a cachectic patient with probabledissemination, a relief of obstructive symptoms and an improvement of dietarystatus were found. Five patients could be completely independent from theparenteral support. These patients were followed up for the mean observationperiod of 70.8 days. Three patients are still alive as outpatients after a mean of 153days (134 to 169 days) after stenting. Remaining 5 patients died, the median survivaltime was 28 days. Autopsy revealed another obstruction of the transverse colon dueto cancer invasion, in a patient with pancreatic cancer who died 21 days afterstenting. There is no stent obstruction or migration. No other significantprocedure-related complication has been found. Conclusions: D-type stentplacement for the palliative treatment of patients with malignant gastric outletobstruction was technically successful in all patients. Clinical success rate was87.5%. There is no significant complication such as migration and obstruction.

M1367

APC in the Treatment of the Different Types of Gastric

Angiodysplasia a Series of Consecutive Patients Diagnosed

By Acute GI BleedingJosep M. Bordas, Samuel Herrera, Josep Llach, Angels Gines,Maria Pellise, Gloria Fernandez-E, Alfredo Mata, Fernando MondeloThere are few data on APC treatment in the different types of gastric angiodysplasiapresented as acute GI hemorrhage. Aim: To evaluate the efficacy of APC in differenttypes of angiodisplasia admitted with overt bleeding. Patients and Methods: 28consecutive patients actively bleeding due to gastric angiodysplasia were includedover a two-year period. Ten patients had focal angiodysplasia (FA), 11 portalhypertension gastropathy (PHG) and 8 gastric antral vascular ectasia (GAVE).Hematocrit level and bleeding recurrence were considered in the 13.6 months offollow-up. The groups were comparable in age, gender, associated diseases,transfusion requirements before APC treatment and length of follow-up. Therewere no complications related to treatment, The final data of the three groups wereshown in the table. Conclusions: 1- APC is useful and safe in the treatment of thedifferent types of gastric angiodysplasia. 2- The results obtained by APC in thesedifferent types of gastric angiodysplasia were similar.

GroupI FA

GroupII PHG

GroupIII GAVE p Total

Num APC sessions 1.2 G 0.4 2.2 G 2.0 2.3 G 0.9 NS 1.9 G 1.3Follow-up (m) 12.6 G 8.7 12.6 G 6.4 15.6 G 8.2 NS 12.6 G 6.1Initial Hct. 24.3 G 4.7 24.0 G 3.4 24.8 G5.0 NS 24.3 G 7.0Final Hct. 33.2 G 3.4 32.1 G 2.6 33.0 G 5.0 NS 32.7 G 3.5Final Hct O 30% 10/10 (100%) 9/11 (81%) 5/8(62%) NS 24/29(82%)Hct elevation frombasal (%)

42.7 G 29.8 39.3 G 31.7 35.7 G 24.2 NS 39.5 G 38.3

Bleeding recurrence 0 0 0 - 0

Hct: Hematocrit.

M1368

Mortality of Severe Upper Gastrointestinal Bleeding

Under Intensified Immediate Interventional TreatmentHarald Mauler, N. Zwerina, H. BrunnerIntroduction: Despite improved medical and endoscopic management, mortality ofacute upper gastrointestinal (GI) bleeding in high-risk patients (O60 years, massiveblood loss) is still over 20%. In Forrest I bleeding, even 26% of the patientsdie (1). Aims & Methods: Aim of this retrospective study was to evaluate theoutcome of patients with severe GI bleeding in our department for 1 year withregard to overall and bleeding mortality. Standard ICU therapy included primaryhemodynamic stabilization by administration of fluids and packed red cells(hemoglobin !8 g/dL) respectively, continuous infusion of somatostatin (240 mg/hi.v.) and pantoprazole (80 mg as bolus, followed by 8 mg/h i.v.), as well asendoscopic hemostasis during the first 3 hours after hospitalization. Results:Hematemesis was diagnosed in 154 patients at hospitalization; 66 of them fulfilledthe primary inclusion criterion: GI-bleeding Forrest I to IIb (32/34 m/f; meanage 67 G 18 y; hemoglobin 8.3 G 2.0 g/dL). According to Forrest classification,11% showed bleeding type Ia (arterial, spurting hemorrhage), 44% type Ib (oozinghemorrhage), 18% IIa (hemorrhage from visible vessel), and 27% IIb (adherentclot). Four main conditions were responsible for the hemorrhage: duodenal ulcer(41%), gastric ulcer (20%), esophageal ulcer (13%), and esophageal varices (11%).Primary endoscopic hemostasis was feasible in 88% of patients; in 9%, surgicaltreatment was necessary. Two patients died because of hemorrhagic shock. 5-daymortality rate was 8% (n Z 5), and overall mortality 15% (n Z 10). In 8% of thepatients, recurrent bleeding could be stopped successfully. Conclusion:Considering the high risk of the patients included in this study, a comparativelylow mortality rate could be obtained. We attribute this low rate to immediateendoscopic hemostasis and ICU treatment. (1) Ell C, Hagenmuller F, Schmitt W,et al. [Multicenter prospective study of the current status of treatment for bleedingulcer in Germany]. Dtsch Med Wochenschr 1995;120:3-9.

Abstracts

www.giejournal.org Volume 63, No. 5 : 2006 GASTROINTESTINAL ENDOSCOPY AB183