WCIM 2014 SEOUL KOREA 519
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0791 Upper GI Tract
Is Routine Second-Look Endoscopy Effective in Managing Acute Non-Variceal Upper Gastrointestinal Bleeding?
Joon Seok Park1, Joong Goo Kwon1, Jin Tae Jung1, Eun Young Kim1, Seong Woo Jeon2, Kyung Sik Park3, Kwang Bum Cho3, Si Hyung Lee4, Byung Ik Jang4, Chang Heon Yang5, Dong Wook Lee6, Hyun Jin Kim7, Wan Jung Kim8
Daegu Catholic University Medical Center, Korea1, Kyungpook National University Hospital, Korea2, Keimyung University Hospital, Korea3, Yeungnam University College of Medicine, Korea4, Dongguk University College of Medicine, Korea5, Daegu Fatima Hospital, Korea6, Gyeongsang National University School of Medicine, Korea7, Soonchunhyang University School of Medicine, Korea8
Background: The effi cacy of routine second-look endoscopy in acute non-variceal up- per gastrointestinal(UGI) bleeding has been evaluated in several randomized, controlled trials that yielded disparate results. It may be more optimally performed in selected patients at very high risk of rebleeding. This study aims to analyze the clinical and endoscopic factors that contribute to intractable endoscopic hemostasis and to deter- mine the optimal role of second-look endoscopy.
Methods: Prospectively collected UGI bleeding registry data was reviewed and data from 464 patients who underwent UGI endoscopy for acute non-variceal UGI bleeding from 8 hospitals in Korea between February 2011 and December 2013 were analyzed.
Signifi cant predictive factors (P < 0.05) of intractable endoscopic hemostasis in uni- variate analysis were entered in a multivariate logistic regression analysis.
Results: Successful hemostasis was achieved in 394 patients by using initial endo- scopic procedures. Seventy patients at the second-look endoscopy were considered in- tractable or insuffi cient to the initial endoscopic hemostasis, and they required second endoscopic hemostasis. Univariate analysis signifi cantly related intractable endoscopic hemostasis with large amount of transfusion (=5 units), Glasgow-Blatchford score, Rockall score, Forrest bleeding type Ia and degree of initial endoscopic hemostasis.
Multivariate analysis showed that large amount of transfusion and Rockall score were only predictive factors of secondary endoscopic hemostasis.
Conclusions: Large amount of transfusion and Rockall score are identifi ed as inde- pendent risk factors associated with intractable initial endoscopic hemostasis in pa- tients with acute non-variceal bleeding. Second-look endoscopy after initial endoscop- ic hemostasis in these patients is not routinely indicated and be reserved for selected patients with high risk of rebleeding.
PS 0792 Upper GI Tract
Learning Curve for Endoscopic Ultrasonography in Gastric Cancer T Staging Using Cumulative Sum Analysis
Chan Park1, Eun Hye Kim1, Da Hyun Jung1, Hyunsoo Chung1, Sung Kwan Shin1, Sang Kil Lee1, Yong Chan Lee1, Jun Chul Park1
Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroen- terology, Yonsei University College of Medicine, Korea1
Background: Endoscopic ultrasonography (EUS) is an operator-dependent procedure and requires more technical and cognitive skills than a routine endoscopic procedure.
The learning curve for the staging of gastric cancer, however, has not been evaluated.
We aimed to evaluate the threshold number of EUS examinations for gastric cancer T staging.
Methods: We retrospectively reviewed the clinical records of patients who underwent EUS for gastric cancer, performed by trainees at Severance Hospital, Seoul, Korea, be- tween March 2011 and February 2012. Cumulative sum analysis was applied to assess the learning curve for determining the T stage using EUS in trainees.
Results: A total of 553 initial EUS examinations for naïve gastric cancers, performed by 4 trainees, were enrolled in the study. The fi nal T stage was determined by experts using EUS in 332 gastric cancer cases, whereas the T stage of the other 221 lesions was determined by trainees using EUS. Accuracies of EUS examinations performed by trainees and experts were 72.6% and 84.3%, respectively. The number of EUS exami- nations required to reach a fi rst plateau in each trainee was 20, 41, 60, and 65.
Conclusions: The CUSUM scores of all of four trainees in the study reached a plateau within the 65th examination.
PS 0793 Upper GI Tract
Prevalence and Predictors of Gastroesophageal Refl ux Disease in Pregnant Women and its Effects on the Quality of Life and Pregnancy Outcome
Ja Jung Yong1, Ji Won Kim1, Won Jae Choi1, Seong-Joon Koh1, Su Yeon Cho1, Seung Mi Lee2, Byeong Gwan Kim1, Kook Lae Lee1
SMG-SNU Boramae Medical Center, Korea1, Department of Obstetric Gynecology, Seoul National Uni- versity Boramae Hospital, Korea2
Background: The aim of this study was to evaluate the prevalence and predictors of gastroesophageal refl ux disease (GERD) and the effect of GERD on quality of life (QOL) and pregnancy outcomes in Korean pregnant women.
Methods: This study was a prospective, cohort study which followed pregnant women in the second or third trimester. Ninety-four consecutive pregnant women who visited Seoul National University Boramae Hospital for the prenatal test were included in this study. GERD was diagnosed with the use of the GERDQ (gastroesophageal refl ux dis- ease questionnaire). QOL in pregnant women with GERD was assessed using QOLRAD (quality of life in refl ux and dyspepsia questionnaire). Pregnancy outcome was evalu- ated with obstetric records after delivery.
Results: Twenty eight (29.8%) of 94 women were diagnosed as GERD by GERDQ. His- tory of GERD in pre-pregnancy was associated with the development of GERD during pregnancy (OR, 3.44; 95% CI, 1.03 – 11.51; P = 0.045). On aspects of QOL, emotional stress (P=0.014), sleep problem (P=0.015), food/drink problem (P=0.004), and vitality (P=0.029) were more prevalent in pregnant women with GERD. Pregnancy outcomes as assessed by birth weight, Apgar score, pre-term birth, and gestational age at par- tum were not different between the two groups.
Conclusions: The prevalence of GERD during pregnancy is common in Korean pregnant women and GERD negatively infl uences on the quality of life of pregnant women.
PS 0794 Upper GI Tract
Comparison of Helicobacter pylori Eradication Rate Between Iatrogenic and Non-Iatrogenic Gastric Ulcer
Sung Bum Kim1, Si Hyung Lee1, Ho Chan Lee1, Se Hoon Sohn1, Jae Hyun Park1, Yo Han Jeong1, Kook Hyun Kim1, Kyeong Ok Kim1, Byung Ik Jang1, Tae Nyeun Kim1, Heon Ju Lee1
Yeungnam University Mecical Center, Korea1
Background: Some studies reported that eradication rate of Helicobacter pylori (H.
pylori) in gastric ulcer disease is higher than non-ulcerative gastric disease. Virulence factor and genotypes of H. pylori concerning non-iatrogenic gastric ulcer and iatro- genic gastric ulcer is different and may affect eradication rate. Aim of this study was to compare H. pylori eradication rate between iatrogenic and non-iatrogenic gastric ulcer.
Methods: Among patients with iatrogenic gastric ulcer from endoscopic removal of tubular adenoma or early gastric cancer or non-iatrogenic gastric ulcer from Jan, 2009 to Dec, 2013 in Yeungnam university hospital, patients diagnosed as H. pylori infection and treated were enrolled as iatrogenic gastric ulcer group and peptic ulcers with H.
pylori infection as non-iatrogenic gastric ulcer group. Their medical records were re- viewed and analyzed retrospectively.
Results: Among 274 patients enrolled, 166 patients had iatrogenic gastric ulcer and 108, non-iatrogenic gastric ulcer. Mean age (years ± SD) was 64.5 ± 8.8 in iatrogenic group and 54.7 ± 11.7 in non-iatrogenic group with signifi cant difference (p =0.006).
Conclusions: Success rate of H. pylori eradication was signifi cant lower in patients with iatrogenic gastric ulcer following endoscopic removal of adenoma or early gastric cancer than non-iatrogenic gastric ulcer. As eradication of H. pylori in iatrogenic gas- tric ulcer has preventive role, further studies to fi nd ways to raise H. pylori eradication rate in iatrogenic gastric ulcer is needed.
