Mo1378Endoscopic Submucosal Dissection(ESD)for Residual orRecurrent Colorectal Adenomas: a Single Center ExperienceStefania De Lisi*, Giancarla Fiori, Davide Ravizza, Cristina Trovato,Giuseppe De Roberto, Annalisa De Leone, Darina Tamayo,Cristiano CrostaDivision of Endoscopy, European Institute of Oncology, Milan, ItalyBackground and Aims: Endoscopic submucosal dissection (ESD) of refractorycolorectal polyps is a challenging procedure carrying higher risk of complicationand lower rate of radical resection than “naïve” lesions. To date, few westerndata is available for ESD in this setting. This study aims to evaluate thefeasibility, safety and efficacy of ESD for colorectal polyps refractory to previousendoscopic resection. Material and methods: ESD was performed according toYamamoto’s technique in patients with residual or recurrent polyps with adiameter � 10mm, deemed as unsuitable for further endoscopic treatment.Single channel endoscopes were used for ESD: a gastroscope (Pentax EG2990i,Japan) for rectal polyps, a colonscope (Pentax EC3890Fi, Japan) for colonic ones.A standard needle knife, hook knife and Mucosectom (Pentax, Japan) were usedfor ESD. Results: Eleven consecutive patients (4/7 M/F mean age 70.6 years) withresidual or recurrent colorectal polyps (4 colonic, 7 rectal) were treated. Colonicpolyps were located in the sigmoid colon (n�1), in descending colon (n�1), atthe splenic flexure (n�1) and in transverse colon (n�1). Median number ofprevious treatment was 2 (range 1-4), 2 patients also had undergone transanalendoscopic microsurgery. Mean polyps diameter was 24mm (range 10-40mm).Mean procedural time � standard deviation was 137 � 75 minutes (range 45-270minutes). En bloc resection rate was 6/11(54.5%). Three perforation (27.2%),occurred during ESD, were managed conservatively with clips application; nobleeding was observed. Radical resection rate (R0) was 6/11(54.5%), in 2 patientsthe margins were not evaluable (Rx) because of coagulation artefacts. Histologyrevealed low grade dysplasia in 5 patients (45.4%) and high grade dysplasia in 6patients (54.5%). A mean endoscopic follow-up of 5.6 months (range 3-12months) was available for 8/11patients, six of them (75%) were free ofrecurrence. During a short follow-up two diminutive, recurrent adenomas (�5mm) were found and treated endoscopically in two patients with non-radical(R1) or non evaluable resection (Rx). Conclusions: ESD, although technicallydifficult, is a relatively safe and effective procedure for treatment of refractorycolorectal polyps in patients otherwise candidates for surgery.

Mo1379Double Balloon Enteroscopy in Patients With PreviousIncomplete Colonoscopy: Should We Perform Them MoreOften?Victoria Gomez*, Mihir K. Patel, Mark E. Stark, Frank LukensGastroenterology and Hepatology, Mayo Clinic, Jacksonville, FLIntroduction: Colonoscopy is a universally performed endoscopic procedure thatis used to evaluate colorectal disease. Limitations due to colon looping,angulation and other anatomical barriers may not allow for successful cecalintubation and thus, complete evaluation of the colon. Double balloonenteroscopy (DBE), traditionally used to evaluate the small intestine, can be usedto evaluate the colon when conventional colonoscopies fail to reach the cecum.Objective: To evaluate the completion rate and diagnostic utility of colonexamination using DBE in patients whom previously had incompletecolonoscopy by standard colonoscope. Design: Single center analysis of aprospectively collected database of patients that underwent retrograde DBE forcompletion of colon examination with history of incomplete colonoscopy,between 2006 and 2011. Results: 44 patients were identified, with a total of 50DBE performed (4 patients with DBE performed twice, 1 patient DBE performedthree times). 45% (20/44) of patients were male. Mean age of patient populationwas 68 years (range 39-84 years of age). Total procedure time average was 64minutes (range 15-138 minutes). The most common indication for colonoscopywas colorectal cancer surveillance (34%) (see Table). DBE completion rate was90% (N�45/50 procedures). Two of the failed procedures were due to poorcolon preparation; 2 due to redundant colon, and 1 due to ventral hernia. Whenexcluding the two procedures with poor colon preparation, the completion rateincreased to 94% (45/48 procedures). No immediate complications werereported. Colon polyps (56%) were the most common findings in DBE, andpolypectomy was the most common therapy performed; polypectomy wasperformed in all 28 procedures in which polyps were detected (see Table).Reasons for previous incomplete colonoscopies in the 44 patients includedsignificant colon looping (61.3%), angulation (20.5%) and 8 patients had missingincomplete information. Conclusion: Retrograde DBE is a complementarydiagnostic and therapeutic technique that can be used in patients with previousunsuccessful colonoscopies using a standard colonoscope. Completion rateswere high at 90% and even higher when excluding those procedures in which apoor colon preparation was observed. Furthermore, diagnostic and therapeuticyields were high, and these procedures can be performed safely and successfullyin a wide range of patient ages, and may be better a better choice for patientswith a known history of challenging and incomplete colonoscopies.

Results of Double Balloon Enteroscopy (DBE) in Patients With PreviousIncomplete Colonoscopies

Indications for colonoscopy: No. of patients (%)

CRC surveillance Overt GI bleeding Colorectalcancer (CRC) screening Anemia Occult GIbleeding Diarrhea Inflammatory bowel diseaseAbdominal pain

15 (34.1) 7 (15.9) 6 (13.6)5 (11.4) 4 (9.1) 4 (9.1) 2

(4.5) 1 (2.3)

Findings on DBE: No. of procedures (%)Normal Polyps Angiodysplasia Colitis Dieulafoylesion N/A due to incomplete colonoscopy

9 (18) 28 (56) 5 (10) 2 (4)1 (2) 5 (10)

Therapy during DBE: No. of procedures (%)Polypectomy Argon plasma coagulation (APC)Biopsy Cauterization Not applicable

28 (56) 5 (10) 1 (2) 1 (2)15 (30)

Mo1380The Effect of Endoscopist Personality on Polyp Detection RatesDuring ColonoscopyMichael Greenspan*, Sharon Jedel, Kumar Bharat Rajan, Todd L. Beck,Garth SwansonRush University Medical Center, Chicago, ILIntroduction: Adenoma detection rate is a known quality indicator ofcolonoscopy in colon cancer screening and varies significantly amongendoscopists. Studies have identified other endoscopist-specific factorscontributing to the differences in detection rates, including withdrawal time ofcolonoscope and physician specialty. Physician personality is one factor whosecontribution to polyp detection has not been examined, yet it has been shown toplay an important role in multiple aspects of medicine, including diagnosis andmedical management choices. We therefore explored the relationship betweenendoscopist personality, adenomatous polyp detection (APD), and hyperplasticpolyp detection (HPD) during colonoscopy. Methods: We conducted a chartreview analysis of patients undergoing outpatient colonoscopy at an academicmedical center to determine APD and HPD rates among ten attendingendoscopists. We reviewed consecutive colonoscopies performed by eachendoscopist between June and October 2010. Endoscopic and histologicaldescription of polyps discovered during endoscopy were recorded.Endoscopistsalso completed the Revised NEO Personality Inventory, an established self-reportmeasure of personality that assesses five major personality domains: Neuroticism,Extraversion, Openness, Agreeableness, and Conscientiousness. Each domain hassix underlying facets. We utilized logistic regression analysis to evaluate statisticalcorrelation. Results: 1279 charts were reviewed with 74 patients excluded forreasons including poor prep or incomplete exam (45), unknown prep quality(14), and polyps without known pathology (15). The average APD and HPD ratewas 26.995% � 5.731% and 12.559% � 3.362%, respectively. By logisticregression analysis, two of the five major domains, Neuroticism [OR 0.994, CI0.988 - 1.00, p-value 0.0488] and Openness [OR 0.993, CI 0.986 - 0.999, p-value0.0208], were inversely correlated with APD. Our analysis showed that HPDcorrelated with Extraversion [OR 1.012, CI 1.003 - 1.020, p-value 0.0062] andOpenness [OR1.011, CI 1.002 - 1.019, p-value 0.014]. Discussion: This is the firststudy to explore the relationship between adenomatous and hyperplastic polypdetection and endoscopist personality. In our study, two personality domainswere significantly correlated with APD and HPD. The results suggest thatendoscopists who are open to novel experiences (less routine) and have moresocial anxiety may also have lower rates of APD, while endoscopists who aremore open to new experiences (less routine) or are gregarious have higher ratesof HPD. Interestingly, endoscopists who scored less routine in their personalityquestionnaire had lower rates of APD and higher rates of HPD, both of whichcould be a marker of a poorer quality colonoscopy exam. Future research iswarranted to more fully understand this relationship.

Mo1381Can Adenoma Detection Rate be a Surrogate for Detection ofProximal Colon Serrated Polyps During Average-RiskColonoscopy Screening?Chang Kyun Lee*1, Hyo-Jong Kim1, Youn Wha Kim2

1Department of Internal Medicine, Kyung Hee University School ofMedicine, Seoul, Republic of Korea; 2Department of Pathology, KyungHee University School of Medicine, Seoul, Republic of KoreaBackground: Several recent studies have indicated that detection of proximalserrated polyps (PSPs) is highly operator-dependent and that detection rate forPSPs (PSPDR) correlates with adenoma detection rate (ADR) during average-riskscreening colonoscopy. However, it is questionable that ADR can be a surrogatefor detection of PSPs. Aims: The aims of this study were to determine whetherADR correlates with PSPDR and to assess the prevalence of PSPs in an average-risk screening Cohort. Methods: We retrospectively analyzed the prospectivelyupdated colonoscopy database, which was intentionally designed to search for

Abstracts

www.giejournal.org Volume 75, No. 4S : 2012 GASTROINTESTINAL ENDOSCOPY AB406