540 32nd World Congress of Internal Medicine (October 24-28, 2014) The Korean Society of Gastroenterology & SIDDS 2014
PS 0865 Lower GI Tract
Treatment Outcomes and Recurrence Following Cold Forceps Polypectomy for Diminutive Polyps
Ho-Su Lee1, Hye Won Hye Won2, Jong-Soo Lee2, Jong Cheol Kim2, Jaewon Choe2, Jae Seung Soh1, Seohyun Lee1, Jungho Bae1, Dong-Hoon Yang1, Seung-Jae Myung1, Suk- Kyun Yang1, Jin-Ho Kim1, Hye-Sook Chang2, Jeong-Sik Byeon1
Department of Gastroenterology, Asan Medical Center, Korea1, Health Screening and Promotion Center, Asan Medical Center, Korea2
Background: The recurrence rate after cold forceps polypectomy (CFP) of diminutive polyps = 5 mm in size has not been fully determined. The aim of this study was to analyze the long-term follow-up results and recurrence rate after CFP of diminutive polyps.
Methods: We retrospectively reviewed the medical records of 884 (738 men; median age, 53 years) asymptomatic subjects who underwent surveillance colonoscopies after CFP of 1-2 diminutive adenomatous polyps at the screening colonoscopy. Cumulative recurrence at the CFP site was analyzed. Risk factors for recurrence were investigated.
Results: Overall recurrence rate during a period of 59.7 months was 17% after CFP of 1,111 diminutive polyps. Defi nite recurrence was 4% and 13% was probable recurrence.
Recurrence as advanced adenoma was 0.5% (5/1,111). The cumulative probabilities of recurrence at 3, 5, and 7 years after CFP were 10.0%, 16.0%, and 21.1%, respectively.
Multivariate analysis revealed that polyps of 4-5 mm and right colonic polyps were risk factors for recurrence (hazard ratio [HR] 1.37; 95% confi dence interval [CI] 1.01- 1.86 and HR 1.49; 95% CI 1.08-2.04, respectively). The recurrence rate of 10 endosco- pists who performed at least 50 CFPs ranged from 11.0% to 25.2%; the probability of recurrence in those with the top half recurrence rate was 1.6-fold higher than that of the other half (95% CI 1.17-2.19).
Conclusions: Although overall recurrence was frequent after CFP of diminutive polyps, recurrence as advanced adenoma was rare. Large polyp size, right colon polyp, and endoscopists were risk factors for recurrence after CFP.
PS 0866 Lower GI Tract
Disease Phenotype, Activity, and Clinical Course Based on the C-Reactive Protein Level at Diagnosis in Crohn’s Disease: Results from the Connect Study
Jong Pil Im1, Jee Hye Kwon1, Joo Sung Kim1, Jae Hee Cheon2, Won Ho Kim2, You Sun Kim3, Byong Duk Ye4, Kang Moon Lee5, Young Ho Kim6, Dong Soo Han7
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Med- icine, Korea1, Department of Internal Medicine and Institute of Gastroenterology, Yonsei University Col- lege of Medicine, Korea2, Department of Internal Medicine, Inje University College of Medicine, Korea3, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Korea4, Department of Internal Medicine, Catholic University College of Medicine, Saint Vincent Hospital, Korea5, Department of Internal Medicine, Sungkyunkwan University School of Medicine, Korea6, Department of Internal Medicine, Hanyang University Guri Hospital, Korea7
Backgroud: Disease course of CD is unpredictable and clinical manifestation is het- erogeneous with phenotypic change. Although several clinical factors, serologic, and genetic biomarkers may be used for the prediction of clinical course, defi nite prog- nostic factor has not been established. CRP is easily measurable noninvasive marker to evaluate disease activity and there’s controversy about the role for prediction of clinical course. Therefore, we designed a study to investigate whether CRP at diagnosis is valuable for identifi cation of disease phenotype, activity, and clinical course in CD.
Methods: We retrospectively analyzed 705 CD patients with measurable CRP level who were enrolled into Crohn’s Disease Clinical Network and Cohort (CONNECT) study in 32 hospitals. Those patients divided into CRP > 2 or CRP = 2 mg/dL at diagnosis.
Patient’s demographic, clinical characteristics, and use of immunosuppressive or bi- ological agents were investigated. Disease location, behavior, number of admission, operation/reoperation were also analyzed based on the CRP.
Results: Of 705 CD patients, 52.9% had CRP > 2 mg/dL at diagnosis. High CRP was associated with young age, steroid use at diagnosis, CDAI at diagnosis, and ileocolonic location (P<0.001, <0.001, 0.001, and <0.001, respectively). Longitudinal ulcer and cobblestone appearance were higher in high CRP group (P<0.001). In disease progress, patients with high CRP were found to have more stricturing feature (P=0.027). There
were signifi cant differences in use of 5-aminosalicylic acid, antibiotics, corticosteroid, and azathioprine (P<0.001, < 0.001, <0.001, and <0.001, respectively). Readmission was also higher in patients with high CRP.
Conclusion: Our study suggested that high CRP level at diagnosis was associated with stricturing phenotype, high disease activity, and more severe clinical course. Patients with high CRP could be considered strict follow-up strategy and examination for early aggressive treatment.
PS 0867 Lower GI Tract
Intestinal Alkaline Phosphatase Ameliorates Experimental Colitis Via Tlr4-Dependent Pathway
Sung Wook Hwang1, Jaeyoung Chun1, Changhyun Lee1, Jong Pil Im1, Joo Sung Kim1 Department of Internal Medicine and Liver Research Institute, Seoul National University College of Med- icine, Korea1
Background: Intestinal alkaline phosphatase (IAP) is an intestinal brush border enzyme, which have a protective effect on colonic inflammation, possibly due to dephosphorylation of lipopolysaccharide (LPS). The aim of the present study was to evaluate whether the effect of IAP was mediated via LPS/Toll-like receptor 4 (TLR4)/
NF-κB pathway.
Methods: Peritoneal macrophages from wild-type (WT) and TLR4-/- mice were pre- treated with IAP, and stimulated with LPS. The secretion of proinfl ammatory cytokines was measured by ELISA. The effect of IAP on NF-κB signaling was evaluated by Western blot and EMSA. Immunofl uorescence was performed to confi rm the effect of IAP in WT and TLR4-/- macrophages. For in vivo study, dextran sulfate sodium (DSS) was given for 7 days in WT and TLR4-/- mice, and IAP was administered by oral gav- age as preventive or therapeutic models. The effect of IAP on colitis was evaluated by disease activity score and histology, and NF-κB activity in colitis tissue was assessed by immunohistochemistry.
Results: The secretion of TNF-a and IL-6 was significantly inhibited by IAP in LPS-stimulated WT macrophages, whereas the effect of IAP was strongly decreased in TLR4-/- macrophages. In WT macrophages, the IκBa phosphorylation and NF-κ B DNA binding activity were more attenuated by IAP compared with TLR4-/- mac- rophages. The immunofl uorescence staining of p65 confi rmed the inhibitory effect of IAP on NF-κB in WT macrophages. In both preventive and therapeutic models of WT mice, but not of TLR4-/- mice, oral administration of IAP signifi cantly reduced loss of body weight, disease activity score and/or histologic grade of colitis. The inhibitory ef- fect of IAP on p65 and phosphorylated IκBa expressions was also found in WT colitis tissue, but the effect was attenuated in TLR4-/-.
Conclusions: These results revealed that IAP has a protective effect on experimental colitis via TLR4-dependent pathway.
