Abstracts

more routinely. Perforation caused by endoscopic removal of foreign bodiesis much rarer than has been described in the historical literature.

Tu1377Esophageal Stent Fixation Using a Novel Endoscopic SuturingDeviceMarc F. Catalano*1,2, Serge a. Sorser1,2, Joseph B. Henderson1, Shahid Ali1,Antwan Atia1,21GI Associates, LLC, Milwaukee, WI; 2Aurora Health Care, Milwaukee, WIThe covered esophageal stents are effective in rapidly relieving dysphagia andaspiration symptoms in patients with advanced esophageal cancer and thosewith tracheoesophageal fistulas respectively. However, migration is the mostcommon drawback associated with fully covered metallic self-expandingesophageal stents (SEMS). Modifications in design such as the conical shapedFlamingo Wallstent and Ultraflex Stent with proximal flaring have improvedanchoring of stents to the tissue. Affixing the proximal end of the stent withendoscopic clips could potentially reduce the risk of stent migration. Despitethese new stent designs and the application of endoclips, esophageal stentmigration is the most frequently encountered problem and prevention ofstent migration continues to be challenging.Aim: To determine the feasibilityand success of esophageal self-expanding metal stent fixation in the primaryprevention of stent migration using an endoscopic suturing device.(Over-stitch, Apollo Endosurgical, Austin, Texas). Methods: Technique is as follows:initial SEMS deployment under fluoroscopic control followed by placement ofsutures at 12, 4 and 8 o’clock at the proximal portion of the stent usinginterrupt sutures. The appropriate stent length was selected dependent onindication (Benign vs. Malignant) and length of esophagus requiring bypass.Fully covered stents were chosen and deployed using continuous fluoros-copy. Once deployed and radial expansion completed, the Overstitch devicewas advance to the proximal portion of the stent. The sutures were subse-quently placed, attaching the stent to the deep layers of the esophaguslumen at 3 quadrants. Results: A total of 8 patients presented for stent fixa-tion into two groups. Group I: benign disease (nZ4) patients. Group II:malignant disease (nZ4) patients. Of those patients with benign disease, onehad a benign stricture and three had esophageal fistulas (one patient hadpreviously migrated stent). Of those patients with malignant disease, one hadpreviously migrated stent. All patients had deployment of SEMS with threesutures placed. All patients resumed pureed diet within 24 hours. Averagefollowup was 6.5 months with no stent migration in either patient group.Discussion: Self expanding metal stents (SEMS) are frequently used for bothbenign and malignant esophageal disease. Downstream migration is problem-atic and can complicate both benign and malignant disease indications. Endo-scopic suturing of the proximal portion of the stent to the esophageal wallsuccessfully eliminates stent migration and should be used liberally in thesegroups of patients.

Tu1378Clinical and Procedural Predictors of Refractory Anastomotic andRadiation-Induced StricturesAaron H. Mendelson*1, Aaron J. Small2,3, Anant Agarwalla4,Frank I. Scott2,3, Michael L. Kochman2,51Department of Internal Medicine, University of Pennsylvania PerelmanSchool of Medicine, Philadelphia, PA; 2Department of Gastroenterology,University of Pennsylvania Perelman School of Medicine, Philadelphia,PA; 3Center for Clinical Epidemiology and Biostatistics, University ofPennsylvania Perelman School of Medicine, Philadelphia, PA;4University of Pennsylvania Perelman School of Medicine, Philadelphia,PA; 5Wilmott Center for Endoscopic Innovation, Research, and Training,Philadelphia, PABackground: Radiation-induced and anastomotic strictures are two of the most diffi-cult types of esophageal strictures to remediate with endoscopic dilation. Risk fac-tors for refractoriness are not well defined. Objective: To identify risk factorsassociated with refractory radiation-induced and anastomotic strictures. Methods: Aretrospective chart review of patients with anastomotic or radiation-induced stric-tures who underwent endoscopic dilation from October 2007- October 2012 wasperformed. Refractory strictures were defined as those in which luminal patencycould not be achieved after 5 dilation treatment sessions over a 10-week period.Several a priori risk factors were analyzed by univariate analysis to determine pre-dictors of refractory strictures. Significant predictors (P!0.20) in univariate analysiswere then included in a stepwise elimination multiple-regression model to identifythe most important risk factors. Results: 63 patients with radiation-induced stricturesand 78 patients with anastomotic strictures underwent 303 and 598 dilations,respectively. There were 27(43%) refractory strictures in the radiation cohort and54(69%) refractory strictures in the anastomosis cohort, of which 49/78(64%) alsounderwent prior radiation. For radiation-induced strictures, use of fluoroscopyduring initial dilation (adjusted OR (aOR) 28.95; 95% CI, 4.96-168.95) and a history

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of head and neck cancer or metastases (aOR 4.47; 95% CI, 1.06-18.87) were signif-icantly associated with refractory strictures. In refractory anastomotic strictures,multivariate analysis showed that use of fluoroscopy during dilation (aOR 10.55; 95%CI, 2.73-40.77) had a positive association, while prior treatment with neoadjuvantchemotherapy (aOR 0.28; 95% CI, 0.08-0.98) was inversely associated. Targetedsteroid injection was significant by univariate analysis and appeared to have a pos-itive association with refractory anastomotic strictures but was not statistically sig-nificant in the multivariate model (aOR 3.36; 95% CI, 0.57-19.94). Female sexappeared to be associated with refractory strictures in both cohorts (radiation aOR3.31; 95% CI, 0.86-12.65; anastomotic aOR 3.36; 95% CI, 0.57-19.94), although notstatistically significant in multivariate analysis. Conclusions: 1] Both anastomotic andradiation-induced strictures have high rates of refractory stenosis. 2] Fluoroscopicguidance appears to indicate a high likelihood of refractoriness to dilation in anas-tomotic strictures, while prior neoadjuvant chemotherapy is associated with areduced risk. In radiation-induced strictures, the use of fluoroscopy and the type ofcancer are both associated with reduced dilation effectiveness. 3] Risk stratificationbased on these factors may better predict which patients should undergo endo-scopic dilation vs. alternative therapy including endoprosthetics and surgical revi-sion.

Tu1379Prediction of Clinical Outcome of PerOral Endoscopic Myotomy(POEM) in Achalasia PatientsJun-Hyung Cho*1, Joo Young Cho1, Weon-Jin Ko1, MI-Young Kim1,Seong Ran Jeon1, Tae Hee Lee1, Su Jin Hong21Digestive Disease Center, Soonchunhyang University Hospital, Seoul,Republic of Korea; 2Department of Internal Medicine, SoonchunhyangUniversity Hospital, Bucheon, Republic of KoreaBackgrounds: Peroral endoscopic myotomy (POEM) was introduced as an alterna-tive treatment for achalasia patients. However, predicting factors for clinicaloutcome remain undetermined in patients underwent POEM. Methods: FromNovember 2011 to August 2013, we reviewed clinical outcome and medical recordsof 28 patients, retrospectively. Clinical variables including patient`s sex, age, diseaseduration, achalasia subtype (sigmoid or non-sigmoid), esophageal diameter, HRMfinding (type 1,2,3), length of myotomy, type of myotomy (full or partial) wereanalyzed. Clinical symptom score (Eckardt score) was compared before and afterPOEM. When post-POEM score was 0 or the score was decreased by 6 or more, itwas defined as successful outcome. Results: A total of 21 patients showed successfuloutcome. Of these, 17 patients showed post-POEM score was 0. However, the re-maining 7 patients did not show successful outcome. Univariate and multivariateanalyses were performed for finding the predictors related to successful POEM. Onunivariate analyses, the short disease duration and non-sigmoid type achalasia wererelated to successful POEM (PZ 0.092 and PZ 0.056, respectively). However, therewere no statistical significance. The small esophageal diameter was significantlyassociated with successful outcome (P Z 0.020). Multivariate analyses also showedthe significant association between the small esophageal diameter and successfuloutcome (P Z 0.027). Conclusions: The short-term outcome of POEM for achalasiawas excellent. Dilated esophageal diameter before POEM was only predictor ofshort-term outcome. Esophageal diameter % 5 cm was associated with successfuloutcome.

Tu1380The Correlation of Timed Barium Esophagogram and EsophagealTransit Scintigraphy in AchalasiaYoo MI. Park*, Jie-Hyun Kim, Young Hoon Youn, Hyojin ParkInternal Medicine, Gangnam severance hospital, Yonsei UniversityCollege of Medicine, Seoul, Republic of KoreaIntroduction: The advent of high-resolution esophageal manometry led to the for-mation of widely accepted Chicago classification, which classifies achalasia intothree subtypes. Timed barium esophagogram (TBE) and esophageal transit scin-tigraphy (ETS) have been adopted as useful ways to evaluate achalasia patients. Aim:In the patients with achalasia, which were diagnosed by high resolution manometry(HRM), we will exam the results of TBE and ETS. And by comparing two tests resultsbefore and after treatment, we will assess the usefulness of two tests as a means toevaluate treatment response. In addition, the replaceability of ETS by TBE will beassessed through correlation analysis between the two tests. Subjects & Methods: Aretrospective study was conducted on 28 patients, diagnosed with achalasia by HRMfrom July 2011 to July 2013. 24 patients received treatment (20 by endoscopicballoon dilatation, 2 by botulinum injection, 2 by per oral endoscopic myotomy).Barium column height and width(cm) at 1 and 2 minutes after barium ingestionwere measured in TBE. Half-life(T1/2, minutes) and R30(%, percentage of remainingradioactivity 30 seconds after isotope injection) were measured in ETS. Both testswere performed before and after treatment. And then, we analyzed the correlationbetween the parameters of two tests. Results: 13 patients(47%) were categorized asType I, 10(35%) as type II, 5(18%) as type III. Before treatment, the barium columnheight(cm) was type I: type II: type IIIZ12.8: 17.6: 5.00 and the barium columnwidth(cm) was type I: type II: type IIIZ4.80: 4.36: 3.00 at 1-minute delay image in

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