Abstracts

helpfulness as determined by physician questionnaire. Of note, 21 patients (26.7%)who underwent ERCP had pancreatic stones removed with the majority of thesepatients experiencing improvement in pain (65%) and ARP (61%). Conclusions:Therapeutic ERCP was undertaken in nearly half the patients within the INSPPIREwith ARP and CP and was most helpful when performed to relieve obstructionsecondary to pancreatic stones. The effectiveness of ERCP in the setting of recurrentpain, acute recurrent pancreatitis, pseudocyst management, removal of biliarystones and management of jaundice in the INSPPIRE population needs to be furtherinvestigated using prospective data collection. On behalf of INSPPIRE Consortium,supported by NIH R21 DK096327, CTSA 2UL1 TR000442-06 and REDCap

Table 1. Procedures performed during ERCP for various indications alongwith reported helpfulness.

Su1756Endoscopic Ultrasound (EUS): a Proposed Role in PediatricEosinophilic Esophagitis (EoE)Fernando J. Windemuller*1, Evan B. Grossman2, Hanh Vo1,Virginia Anderson3, Raavi Gupta3, Steven M. Schwarz1,Simon S. Rabinowitz11Pediatric Gastroenterology, SUNY Downstate Medical Center, Brooklyn,NY; 2Gastroenterology, SUNY Downstate Medical Center, Brooklyn, NY;3Pathology, SUNY Downstate Medical Center, Brooklyn, NYIntroduction: Previously, EUS has documented increased esophageal (esph) totalwall thickening (TWT) in Pediatric Eosinophilic Esophagitis (EoE) compared tochildren with gastroesophageal reflux (GER) and decreased TWT in adults who re-sponded to EoE treatment. This report describes EUS data obtained in a longitudinalstudy on the evolution of Pediatric EoE . Methods: 18 patients ( M:14, F:4, mean age10 +/-6y, range 3- 20Y) with known EoE (previous esph biopsy O15 eos/hpf) had 28EUS exams performed utilizing a 12 or 20mHz ultrasound probe at the mid-esph(nZ27) and distal-esph (nZ28) prior to obtaining esph biopsies at the same sites.Five patients who were studied for suspected EoE were found to have GER. Two EoEpatients were found on subsequent endoscopies to have histology consistent withEGID (increased eosinophils in the stomach and duodenum). Results: 4 EoE pa-tients in remission (EoE-R; eos!15/hpf in both biopsies) had EUS, one of whom hadprevious belonged to the EoE-A group but underwent remission after treatment.The mean TWT obtained in these EoE-R exams was mid-esph Z 2 � 0.9 mm (range1.1-3.9mm) and distal-esph was 1.9 � 0.3 mm (range 1.5 - 2.3mm). One boy whowas EoE-A went into histologic remission but maintained and increased TWT. Thesevalues were similar to GER. 8 other patients had active disease (EoE-A; O15 eos/hpfin mid and/or distal-esph). EUS in this group revealed mean TWT in the mid-esphZ2.2� 0.5mm (range 1.1-2.6) and in distal-esph Z 2.4� 0.6mm (range 1.2-3.1). Asshown in adults, effective EoE therapy can decrease eos and TWT. Two children withEoE, later found to have EGID had esph TWT, eos/hpf and clinical responses iden-tical to EoE. Discussion: These results suggest EUS can complement mucosalbiopsies in clinical decision making and assessing the progression of EoE.

Su1757Pediatric Gastroenterologists Performing ERCP: a US SurveyDavid Troendle*1, Douglas S. Fishman4,5, Victor L. Fox3,Bradley a. Barth1,21UT Southwestern Medical Center, Dallas, TX; 2Children’s MedicalCenter Dallas, Dallas, TX; 3Boston Children’s Hospital, Boston, MA;4Texas Children’s Hospital, Houston, TX; 5Baylor College of Medicine,Houston, TXBackground: While endoscopic retrograde cholangiopancreatograpy (ERCP) hasbeen shown to be safe and effective in patients of all ages, little is known about

AB286 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 5S : 2014

number, training, and scope of practice of pediatric gastroenterologists (PedGEs)who independently perform this procedure in children. The goal of this surveywas to better quantify the training, volume, and scope of practice of PedGEscurrently performing ERCP. Methods: With IRB approval, A REDCaps survey wasadministered to 68 PedGEs who manage endoscopy operations for their academicor private practice according to a national endoscopy register. Centers withPedGEs performing ERCP were queried about initial training, cumulative andannual case volume, scope of practice, continuing medical education (CME), andquality monitoring, all specifically related to ERCP. Results: The survey had aresponse rate of (32/68) 47% and identified 12 PedGEs who performed ERCP forsome or all indications. Four (33%) of these endoscopists had completed a formaladult therapeutic endoscopy fellowship, while the remainder gained experienceunder the guidance of an experienced adult endoscopist in an informal setting.Three (25%) had performed!100, 2 (17%) had performed between 101-150, and7 (58%) had performed O150 ERCPs prior to independent practice. Five (42%)have been independently performing ERCP for more than 5 years. Seven (58%)perform greater than 40 ERCPs annually. All but one respondent performed ERCPfor all complexity grade 1 and 2 indications and selectively placed prophylacticpancreatic stents to prevent post-ERCP pancreatitis, which is the threshold forindependent practice recommended by the American Society for GastrointestinalEndoscopy (ASGE). Respondents more variably performed grade 3 and 4 ERCPswith most seeking assistance when specialized equipment or advanced techniqueswere needed. Forms of CME included additional supervision by an experiencedadult endoscopist (5, 42%) and either hands-on (3, 25%) or non-hands-on (8, 67%)ERCP coursework. Quality monitoring using an individual database was performedby all but one respondent. Conclusions: Very few PedGEs perform ERCP, mostoften after training informally under the guidance of an experienced adult endo-scopist. Nearly all meet or exceed the practice complexity threshold for inde-pendent practice recommended by the ASGE and the majority pursue procedure-specific CME and quality monitoring. Yet, they fall short of commonly recom-mended training thresholds and annual volume targets. Research is needed todetermine what ERCP training and volume thresholds will enable PedGEs toachieve acceptable rates of technical success and clinical improvement with min-imal adverse events.

Su1758Single Balloon Small Bowel Enteroscopy in Children: a SingleCenter Review of 37 CasesRobert Kramer*Pediatrics, University of Colorado, Aurora, COBackground: Since balloon enteroscopy was initially described in 2001 there havebeen limited reported series in children, with the majority of these from outsidethe U. S. and employing double rather than single balloon enteroscopy. Objectives:To describe a relatively large cohort of children undergoing single balloon entero-scopy at a pediatric academic tertiary care center in the U. S. Methods: A total of 37enteroscopies (both antegrade and retrograde) were performed in 34 children andadolescents (21 male) between November 2007 and December 2013. All procedureswere performed by a single pediatric endoscopist, utilizing the Olympus SIF-Q180enteroscope and single balloon overtube (OD 13.2 mm). An Olympus ballooncontrol unit was used, with a set pressure of 5.4 kPa � 2.6 kPa. The Procedures wereall performed with fluoroscopic guidance and under general anesthesia. Results: Themean age of the patients was 10.8 years (SD 5.5, range 2.1 to 24 years) with a meanweight of 37.7 kg (SD 20.8, range 11.8 to 77.2 kg). Of the total, 29 procedures(78.4%) were antegrade and 8 were retrograde. A preceding capsule study wasperformed in 19 (51.4%) and 12 studies (29.7%) were interventional. Endoscopicinterventions included polyp removal in 6, attempted removal of retained surgicalstents (post liver transplant) in 3, dilation in 2 and endoscopic treatment of bleedingin 1. In 30 studies (81.1%) the procedure was felt to be technically successful invisualizing the targeted area of small bowel, with no significant difference in successrates between antegrade and retrograde procedures (pZ0.143). The mean durationof procedures was 86.2 minutes (SD 31.9, range 46 to 180 min). The average numberof advancement cycles was 5.0 (SD 1.6, range 1 to 8) and the estimated depth ofinsertion beyond the pylorus or ICV was 140.5 cm (SD 64.4, range 0 to 240)respectively. The mean fluoroscopy time, when measured, was 78.8 seconds (SD27.9, range 48 to 110 seconds). Post-enteroscopy complications were encounteredin 3 patients (8.11%): two with abdominal pain, resulting in a negative evaluation inthe emergency department (Grade 2) and one with fever in the context of a centralline, resulting in admission (Grade 3) but negative cultures. In no patient was therean identified hemorrhage, infection, or perforation. In 17 cases (46.0%) the en-teroscopy was felt to have significantly altered or impacted the patient treatmentplan. Conclusions: Single balloon enteroscopy can be safely and successfully per-formed even in small pediatric patients, down to 12 kg. Further study is needed,however, to optimally define the indications for these procedures to maximize theirdiagnostic yield.

www.giejournal.org