Sa1477 Monotherapy vs. Combination Therapy for Hemostasis in Peptic Ulcer Disease—7-Year Experience At a Tertiary Care Academic Medical Center

Monotherapy vs. Combination Therapy for Hemostasis in Peptic Ulcer Disease—7-Year Experience At a Tertiary Care Academic Medical Center Nazia Hasan*, ADAM Snyder, Farid Razavi, Mark B. Pochapin, Seth a. Gross Medicine, New York University Langone Medical Center, New York, NY Background: Current practice guidelines recommend the use of thermal therapy or clips with or without epinephrine for the treatment of peptic ulcer disease (PUD) with high risk stigmata. However, there is a paucity of evidence to guide the use of cautery or clips alone vs. in combination with epinephrine. Aim: To analyze rebleeding rates in patients who receive either clip or cautery alone vs. clip or cautery with epinephrine. Methods: We performed a retrospective chart review at a single tertiary care academic center. The center’s electronic endoscopy database was queried for the diagnosis of ulcer in the stomach and/or duodenum between 10/2005 and 10/2012. Patients who had clean based ulcers, pigmented material, or adherent clots were excluded from final analysis. The electronic patient records were then reviewed and demographic, clinical, and endoscopic data were recorded. Rates of rebleeding at 72 hours and requirement for interventional radiology or surgical intervention during hospitalization were analyzed. Two-tailed p values were calculated using Fisher’s exact test to compare clip or cautery alone vs. clip or cautery with epinephrine. Results: Over a 7-year period, there were 1033 endoscopies with the diagnosis of PUD of which 105 patients met criteria for inclusion. The median age was 75.5 years with a slight male predominance (61, 58%). There were 70 (66.7%) patients with active bleeding (oozing or spurting) and 35 (33.3%) with a nonbleeding visible vessel. The majority of patients (45.7%) underwent cautery with epinephrine vs. cautery alone (17.1%) vs. clip alone (16.2%) vs. clip with epinephrine (9.5%). Rebleeding at 72 hours occurred in 18 of 105 patients (17.1%). There was no statistically significant difference between monotherapy with clip or cautery compared to dual therapy with epinephrine. Specifically, the rebleeding rates of cautery alone vs. cautery with epinephrine (22.2% vs. 12.5%, p 0.44) was not significant. The clip alone group had the lowest incidence of re-bleeding (5.9%). There was a trend towards lower re-bleeding rates in clip alone vs. clip with epinephrine (5.9% vs. 30%, p 0.13). As expected, a significantly larger proportion of patients in the clip alone group were observed to have a non-bleeding visible vessel rather than active bleeding as compared to the clip with epinephrine group. See Table 2. Conclusions: There was no statistically significant differences in rebleeding rates among the intervention groups. However, there was a trend towards lower rebleeding rates in the clip alone group compared to the clip with epinephrine group on high-risk stigmata. It is possible that the administration of epinephrine may impede the ability of clips to grasp mucosal tissue for maintenance of hemostasis. Further studies to investigate the efficacy of clips with and without epinephrine are warranted. Sa1478 Clinical Impact of Capsule Endoscopy on Long-Term Outcome in Patients With Obscure Gastrointestinal Bleeding: a Multicenter Study in Korea Yang Won MIN*, Jin Su Kim, Seongwoo Jeon, Yoon Tae Jeen, Jong Pil IM, Dae Young Cheung, Myung-Gyu Choi, Jin-OH Kim, Kwang Jae Lee, Jae Hee Cheon, Byong Duk Ye, Ki-Nam Shim, Jeong Seop Moon, Ji Hyun Kim, Dong Kyung Chang Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Seoul St. Mary’s Hospital, College of Medicine, The Catholic University, Seoul, Republic of Korea; Kyungpook National University Hospital, Daegu, Republic of Korea; Korea University Hospital, Seoul, Republic of Korea; Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Yoido St. Mary’s Hospital, College of Medicine, The Catholic University, Seoul, Republic of Korea; University of Soonchunhyang, Seoul, Republic of Korea; Ajou University Hospital, Suwon, Republic of Korea; University of Ulsan College of Medicine, Asan The cumulative overall survival rates in GOV1 and GOV2 group. Abstracts