WCIM 2014 SEOUL KOREA 551
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0908 Lower GI Tract
Polyp and Adenoma Detection Rate for the Colonoscopy Performed by Trainees
Jongkyoung Choi1, Jong-Pil Im2, Joo Sung Kim2, Hyun Chae Jung2
Department of Internal Medicine, National Medical Center, Korea1, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Korea2
Background: The polyp detection rate (PDR) has been used an alternative quality indicator of colonoscopy to the adenoma detection rate (ADR). Both PDR and ADR are calculated for the entire colon, but recent studies have demonstrated that PDR accurately estimated ADR in the right colon, but not in the rectum and sigmoid. Little is known about the correlation between PDR and ADR in depending on colonscopic training level. The aim of this study is to assess the effect of training level to deter- mine whether the PDRs correlate with their ADRs in individual colonic segments.
Methods: This is a prospective study for first-year gastrointestinal fellows at an academic hospital during an 8-month training period. We excluded incomplete and emergency procedures, and those performed in patients with inflammatory bowel disease, history of colorectal surgery or colorectal cancer. We calculated the PDR and ADR (number of colonoscopies with at least 1 polyp or adenoma detected, respective- ly, divided by the number of colonoscopies) for each endoscopists, using data from the entire colon and then for each colonic segment separately.
Results: During 2386 colonoscopies, 2122 polyps were removed; 1398(65.8%) were adenomas. The mean of the PDR and the ADR were 0.45±0.05 and 0.32±0.03, respec- tively. Endoscopist’s PDRs correlated well with their ADRs (Pearson’s correlation coeffi - cient r = 0.73, p=0.02). There was no signifi cant difference in the correlation between PDR and ADR depending on learning curve as well as colonic segment.
Conclusions: We observed a well correlation in PDR and ADR regardless of training level and in colonoscopies by fellows. The PDR may be as a surrogate for ADR, regard- less of the learning curve.
PS 0909 Lower GI Tract
Circumferential Submucosal Incision Prior to Endoscopic Mucosal Resection Provides Comparable Clinical Outcomes to Submucosal Dissection for Well Differentiated Neuroendocrine Tumor in Rectum
Dae Young Cheung1, Hyung-Keun Kim1, Young-Seok Cho1, Sung Soo Kim1, Jin IL Kim1, Soo-Heon Park1, Hiun-Suk Chae1, jae Kwang Kim1
The Catholic University of Korea Collge of Medicine, Korea1
Background and aim: Small rectal neuroendocrine tumors (NETs) can be treated with endoscopic resection. Endoscopic submucosal dissection (ESD) has been accepted as a reliable technique, but very diffi cult to do. This study aimed to evaluate the feasibility and effi cacy of precut and endoscopic mucosal resection (CSI-EMR) for rectal NETs comparing to ESD.
Materials and Methods: From January 2011 to March 2013, patients with rectal NETs were enrolled consecutively. ESD or CSI-EMR was performed on operator’s discretion.
Histological and clinical outcomes were measured and compared between the two treatment modalities.
Results: A total of 33 patients were enrolled during the study periods. Seventeen NETs were treated in ESD method and 16 were in CSI-EMR. Both groups had similar mean tumor diameters (ESD 7.53 ± 1.94 vs. CSI-EMR 6.63 ± 1.99 mm; p = 0.197).
En bloc resection was achieved in 100% of ESD group and 87.5% of CSI-EMR group.
Lateral margin involvement occurred in 1 patient in ESD group and 2 in CSI-EMR group. Histologically complete resection rate was 88.2% (15 of 17) in the ESD group and 81.2% (13 of 16) in CSI-EMR group (p = 0.592). One case of perforation occurred in both group. Delayed bleeding did not happen. All measured outcomes above were not different between the two groups. Operation time was signifi cant shorter in CSI- EMR group than in ESD group, 9.69 minutes and 20.12 minutes respectively (p-value = 0.004).
Conclusion: CSI-EMR results in reliable clinical outcomes for small rectal NETs compa- rable to that of ESD. The CSI-EMR is technically feasible and more time saving.
PS 0910 Lower GI Tract
The Comparison of Clinical Outcomes of
Pseudomembranous Colitis Between Young and Old Inpatients
Ho Chan Lee1, Kyeong Ok Kim1, Se Hoon Sohn1, Jae Hyun Park1, Yo Han Jeong1, Sung Bum Kim1, Kook Hyun Kim1, Si Hyung Lee1, Byung Ik Jang1, Tae Nyeun Kim1 Yeungnam University Mecical Center, Korea1
Backgrounds: Advanced age is known as a risk factor of poor outcomes of colitis including pseudomembranous colitis(PMC). The aim of the present study was to com- pare the clinical outcomes of hospitalized case of pseudomembranous colitis between young and old patients.
Methods: From Jan 2007 to Dec 2013, inpatients who were diagnosed as PMC were included and their clinical data were analyzed retrospectively. The patient’s base- line-characteristics, clinical courses and outcomes were compared according to the age with the cutoff 65years.
Results: Among total 241,391 inpatients during the study period, 217 patients(0.09%) had been diagnosed as PMC. Mean age of the patients was 67.4 years and 71 patients (32.7%) were younger than 65years old and the other 146 patients(67.3%) were older than 65years old. Mean age was 49.6 and 76.1 years in each groups and male to fe- male ratio was 0.82 and 0.59 respectively. The Rt. colon involvement was more com- mon in old age (21.2% vs 41.7%, p=0.042). Leukocytosis(40.8% vs 65.0%, p=0.001) and severe PMC scored above 3 points(77.5% vs 89.0%, p=0.024) was more common in old age. Failure to 1st line treatment was more common in old age(16(22.5%) vs 54(37.0%), p=0.033). As an initial treatment, use of vancomycin, instead of metroni- dazole was more frequent in old age(1(1.4%) vs 16(11.0%), p=0.014). Mean duration of NPO was 3.65 and 4.1days in each group (p=0.357). Recurrence rate did not show any signifi cant difference according to age 8.5% vs. 14.4% ,p=0.214).
Conclusions: There was no difference symptom duration and recurrence rate between young and old PMC patients. However, severe colitis and failure to 1st line treatment was signifi cantly more common in old patients. We should consider more aggressive treatment at fi rst in PMC patients above 65years.
PS 0911 Lower GI Tract
Braf Mutation and Igfbg7 Methylation in Colorectal Tubular Adenoma and Serrated Polyps in Koreans
Hyun Sik Kim1, Hee Man Kim1, Otgontuya Sambuudash1, Hannah Jo1, Kyung Ju Lee1, Hong Jun Park1, Jae Woo Kim1, Mee Yon Cho2, Hyun-Soo Kim1
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Korea1, Department of Pathology, Yonsei University Wonju College of Medicine, Korea2
Background: As one of the colorectal cancer carcinogenesis, serrated neoplasia path- way is characterized with BRAF mutation and aberrant DNA methylation.
Methods: Between 2005 and 2013, 146 colon polyps (47 tubular adenoma [TA], 53 traditional serrated adenoma [TSA], 17 sessile serrated adenoma/polyp [SSA] and 29 hyperplastic polyps in proximal colon [PHP] were collected in Yonsei University Wonju College of Medicine. The paraffi n embedded tissues of colon polyps were deparaffi n- ized, DNA was extracted, and polymerase chain reaction (PCR) was performed. BRAF V600E mutation was identifi ed through PCR and pyrosequencing assay, and methyla- tion of LINE-1, IGFBP7, hMLH1, and CD133 was evaluated through disulfi te conversion, PCR, and pyrosequencing assay.
Results: BRAF V600E mutation was found in 2.1% of TA, 47.2% of TSA, 41.2% of SSA, and 20.7% of HP. TSA and SSA had higher BRAF mutation than TA (P<0.0001).
TSA had higher BRAF mutation than HP (P=0.018). IGFBP7 hypermethylation was found in 17% of TA, 37.7% of TSA, 88.2% of SSA, and 37.5% of HP. TSA and SSA had higher hypermethylation of IGFBP7 than TA (P=0.021 and P<0.0001, respectively). SSA had higher hypermethylation of IGFBP7 than HP (P=0.002). hMLH1 hypermethylation was found in 2.1% of TA, 5.7% of TSA, 0% of SSA, and 0% of HP. CD133 hypermeth- ylation was found in 21.3% of TA, 9.4% of TSA, 35.3% of SSA, and 17.4 % of HP.
Conclusions: TSA and SSA have different expression of BRAF V600E mutation and IGFBP7 hypermethylation as compared to TA. HP in proximal colon had different ex- pression of BRAF mutation from TSA, and IGFBP7 hypermethylation from SSA. These fi ndings suggest that TSA and SSA have different genetic alterations from TA or HP.
