WCIM 2014 SEOUL KOREA 555
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0923 Lower GI Tract
Clinical Outcomes of Non-Surgical Management for Post-Polypectomy Microperforation in Patients with Colorectal Neoplasia
Jae Jun Park1, Jeonghyun Kang2, Jinhoon Nam Nam2, Jie Hyun Kim1, Young Hoon Yoon2, Kang Young Lee2, Hyojin Park1, Seung-Kook Sohn2
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Ko- rea1, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Korea2 Background: Although microperforation could occur after colonoscopic polypectomy, clinical outcomes and optimal management strategy for this complicaton is not well known. The aim of this study was to investigate the clinical characteristics of patients who developed microperforation after colonoscopic polypectomy and clinical out- comes of non-surgical treatment for these patients.
Method: Retrospective chart review was performed for the patients who underwent colonoscopic polypectomy and subsequent plain X-ray examination for supervision of perforation between January 2008 and November 2013 in Gangnam Severance hospi- tal. Among them, patients who show pneumoperitoneum on plain X-ray were enrolled for this study. Patients with intraprocedural perforation detected by endoscopist dur- ing polypectomy were excluded.
Results: A total of 12 patients were found with microperforation. Eight patients (66.7%) were male gender and median age was 64.5 years. Before polypectomy, submucosal saline injection was performed in most patients (11 patients, 91.7%) and preventive clipping after polypectomy was carried out in 6 patients(50%). Multiple polypectomy was done in 8 patients (66.7%). The median size of the largest polyp in these patients was 15 mm (interquartile range : 12-20 mm). Laterally spreading tumor was most common (5 patients, 41.7%) gross tumor type. En bloc resection was per- formed in 10 patients (83.3%). Although no patients show peritonitis signs on physical examination, most patients (11, 91.7%) complain of mild to moderate abdominal pain.
After documentation of intraabdominal free air, all patients received intravenous an- tibiotics treatments and fasting was advised in most patients (10 patients, 83.3%). All patients showed no worsening for these conservative treatments and were discharged after median 3 days (interquartile range 2-6.75 days) of hospital stay.
Conclusions: Our study shows that conservative treatment is feasible and could be an primary management option for microperforation by colonoscopic polypectomy in selected patients.
PS 0924 Lower GI Tract
Retrospective Clinical Reviews of Abdominal Tuberculosis
Du Hyeon Lee1, Hyun Soo Kim1, Seon Young Park1, Chang Hwan Park1, Sung Kyu Choi1, Jong Sun Rew1
Chonnam National University Hospital, Korea1
Background: Because the prevalence of tuberculosis is decreasing but that of ex- trapulmonary tuberculosis is increasing, The objective of this study is to evaluate the clinical features and colonoscopic fi ndings of abdominal tuberculosis.
Methods: A retrospective analysis of 130 patients with abdominal tuberculosis who were diagnosed in Chonnam National University Hospital from January 2003 to De- cember 2012 using IBM SPSS Statistics 20.
Results: From 2003 to 2012, there are 130 patients of abdominal tuberculosis includ- ing 87 patients with tuberculous colitis, 27 patients with tuberculous peritonitis and 16 patients with both. There are 44 male patients (33.8%) and 86 female patients (66.2%). Mean age was 50.2±16.3 (17-92). The number of patients has pulmonary tu- berculosis, past pulmonary tuberculosis infection, no known past history of pulmonary tuberculosis was 6(4.6%), 43(33.1%), 81(62.3%) respectively. Symptoms were abdom- inal pain (64.6%), diarrhea (33.1%), fever (15.4%), weight loss (13.1%), hematochezia (5.4%), and bowel obstruction (3.1%). Asympomatic patients were 17.7%. 16 patients had positive Tuberculin skin test (73%) among 22 patients who were examined Tu- berculin skin test. Acid fast bacilli stain was all negative. The positive culture rate of Mycobacterium tuberculosis was 22%. The frequency of positive tuberculosis PCR, positive interferon-gamma release assays was 29.5%, 92.6%, respectively. The colo- noscopic involvement sites were terminal ileum and ileocecal area (88.4%), ascending colon (57.3%), transverse colon (14.6%), descending colon (4.9%), rectum and sigmoid colon (8.7%). The percentage of 1 segment involved, 2 segments involved, more than 3 segments involved was 40.8%, 47.5%, 11.7% respectively. Tissue pathologic features were granulomatous change (46.9%), granuloma (7.3%), caseous change (3.1%).
Conclusion: Because abdominal tuberculosis does not have specifi c clinical features and low positive ratio of many tuberculosis test, proper diagnosis was done through colono- scopic fi ndings, clinical characteristics and improvement after empirical treatment.
PS 0925 Lower GI Tract
Risk Factors for Recurrence in Patients with Clostridium Diffi cile Infection(CDI)
Sun wook Park1, Jae kyu Sung1 Chungnam National University Hospital, Korea1
Aim: To investigate the risk factors associated with recurrence in patients with Clostridium diffi cile infection (CDI)
METHODS: A retrospective study of 244 patients with CDI from January 2009 through December 2013 December was performed at Chungnam National University Hospital.
Results: A total of 244 patients with CDI were identifi ed during the study. The median age of the patients was 72yr (range from 23 to 93yr ). Of the 244 patients, 75(30%) patients experienced one or more recurrences. Prior to the development of CDAD, 219(89%) patients were taken antibiotics, and 42(19.2%) patients received anti-ulcer medication. There were no signifi cant difference on clinical characteristics fi ndings be- tween recurrence group and no-recurrence group. However, low albumin level (< 2.5g/
dL), Ileus, history of anti-ulcer medication and pericolic strands on CT fi nding were found to be more frequent in the recurrent group(p<0.05). In multi-variated analysis, pericolic strands and history of anti-ulcer medication were independently associated with CDI recurrence of (p<0.05).
Conclusion: Pericolic strands on CT fi nding and history of anti-ulcer medication can be the risk factor for CDI recurrence. CT examination in patient with CDI has the auxiliary role in patients with CDI.
PS 0926 Lower GI Tract
Endoscopic Submucosal Dissection for Colorectal Lateral Spreading Tumors Larger Than 10 Cm: Is It Feasible?
Da Hyun Jung1, Young Hoon Youn2, Jie-Hyun Kim2, Hyojin Park2
Department of Internal Medicine, Yonsei University College of Medicine, Korea1, Department of Internal Medicine, Gangnam Severance Hospital, Korea2
Background: Colorectal endoscopic submucosal dissection (ESD) was applied to le- sions, such as giant colorectal lateral spreading tumors (LSTs) >10 cm, by an expert ESD-endoscopist despite several limitations, such as a relatively high perforation rate and high technical diffi culty. Thus, we investigated the feasibility and safety of ESD for giant colorectal LSTs = 10 cm.
Methods: A total of 163 patients underwent colorectal ESD between 2009 and 2014 by a single expert ESD-endoscopist at Gangnam Severance Hospital, Seoul, Korea.
Among them, nine patients had giant colorectal LSTs = 10cm. We compared clinico- pathologic factors associated with ESD between giant colorectal LSTs and others.
Results: Colorectal LSTs =10cm were classifi ed as giant colorectal LSTs. Nine giant colorectal LST lesions were localized to the following regions: descending colon (n=1), sigmoid colon (n=1), and rectum (n=7). The average maximal diameter of giant colorectal LSTs was 120.8 mm, and the procedure time was 270.0 min. Two lesion was of the whole nodular type, and seven were focal nodular lesions. The en-bloc and cu- rative resection rates for ESD for giant colorectal LSTs were 88.9% and 100%, respec- tively. The complication rate was 44.4%. No strictures, local recurrences nor distant metastases occurred over a mean follow-up period of 27.1 months.
Conclusions: ESD of giant colorectal LSTs appears to be a feasible and curative treat- ment, even though it is associated with a higher complication rate, higher degree of technical diffi culty, and longer procedure time.
