Mo1485 Comparison of Direct Endoscopic Injection (DEI) and EUS-Guided Fine Needle Injection (EUS-FNI) of 2-Octyl-Cyanoacrylate for Treatment of Gastric Varices

Mo1484 Endoscopic Ultrasound (EUS) Is Superior to Esophagogastroduodenoscopy (EGD) and Esophageal Capsule Endoscopy (ECE) for Varices Screening Tsion Abdi*, Danielle Marino, Avlin B. Imaeda, Chuhan Chung, Petr Protiva, Anil B. Nagar Digestive Diseases, Yale University School of Medicine, New Haven, CT; Digestive Diseases, West Haven VA, West Haven, CT; Gastroenterology, University of Rochester, Rochester, NY Background: EGD is the standard of care for the diagnosis of esophageal varices while esophageal capsule endoscopy (ECE) is an accepted alternative. Prior studies have not evaluated endoscopic ultrasound (EUS) compared to EGD and ECE in screening for esophageal varices. Aim: To compare the performance of EGD, ECE, and EUS in diagnosing esophageal varices. Methods: A single center prospective blinded study of consecutive patients with cirrhosis referred for variceal screening. Patients underwent three procedures at one visit. ECE with PillCam was performed first and followed by EGD under conscious sedation. An EUS was then done using a TTS 20MHZ probe performed by a different endoscopist. ECE consultant was blinded to the results of the other procedures. Varices were graded as following: EGD small v/s large, ECE small v/s large and EUS by measuring size in mm. SPSS software was used to calculate sensitivity, specificity, predictive value and compare groups for agreement. Results: 52 patients were enrolled in the study. 48 patients completed all three tests. Four patients were excluded due to inability to perform all three tests due to dysphagia, food in stomach and inability to sedate. The mean age was 60 and the average MELD score was 10.8 (range of 7 to 20). Varices were detected by EUS, EGD and ECE in 44, 32, and 38 patients, respectively. Using EUS as a gold standard EGD had a sensitivity of 72.7%, specificity 100%, positive predictive value 100% and negative predictive value 25% respectively. ECE had a sensitivity 79.5%, specificity 25%, positive predictive value 92% and negative predictive value of 10% respectively. The kappa value for agreement between EUS and EGD was .308, denoting fair agreement. The kappa value for agreement between EGD and ECE was .483, denoting fair agreement. The kappa value for agreement between EUS and ECE was .027, denoting poor agreement. EUS varices size was!2mm in 17 patients, between 2mm and 3mm in 18 patients and O3mm in 9 patients. Both EGD and ECE identified!50% of the varices less than 2 mm in size on EUS compared to 85% of varices more than 2 mm in size on EUS (p value equals!.009). Procedures were safe with few complications, 1 patient had bleeding post EGD and 2 patients experienced aspiration with ECE. Conclusions: This study prospectively identifies EUS as the most sensitive test to screen for varices. Further studies are necessary to determine if finding on EUS may reflect changes in early clinically compensated portal hypertension. Mo1485 Comparison of Direct Endoscopic Injection (DEI) and EUS-Guided Fine Needle Injection (EUS-FNI) of 2-Octyl-Cyanoacrylate for Treatment of Gastric Varices Ji Young Bang*, Mohammad A. Al-Haddad, Michael V. Chiorean, Naga P. Chalasani, Paul Y. Kwo, Marwan Ghabril, Marco A. Lacerda, Saurabh Agrawal, Howard Masouka, Raj Vuppalanchi, Eric S. Orman, Margaret S. Sozio, Samer Gawrieh, Craig Lammert, Suthat Liangpunsakul, John M. Dewitt Gastroenterology-Hepatology, Indiana University, Indianapolis, IN; Gastroenterology & Hepatology, Cleveland Clinic, Abu Dhabi, United Arab Emirates; Digestive Diseases institute, Virginia Mason Medical Center, Seattle, WA Background: Gastric varices (GV) can bleed in 10-70% of patients and are associated with significant morbidity and mortality. Endoscopic therapy with 2-octyl cyanoacrylate (CYA) may be performed by direct endoscopic injection (DEI) or more recently by fine needle injection (FNI) under EUS guidance. However, impact of EUS-guided FNI of GV compared to DEI is unknown. Aim: To compare the incidence of rebleeding and adverse events associated with DEI and EUS-FNI of CYA for GV. Methods: Consecutive patients at a single tertiary hospital who underwent DEI with CYA for primary prophylaxis or active/recent GV bleeding between 2/ 2006 and 4/2012 were initially identified. These patients represent our initial experience with endoscopic therapy of GV. To improve outcomes, DEI was abandoned in 2012 in favor of EUS-FNI. Results of FNI using CYA between 1/2013 and 9/2014 for the same patient population were prospectively recorded. Patient characteristics, procedure details and outcomes between the two groups were analyzed. Primary outcome: rate of GV rebleeding %30 (early) or O30 days after (late) therapy. Secondary outcomes: 1) no. of treatments needed for GV eradication; 2) incidence of adverse events (AEs). DEI and EUS-FNI were performed with 23 gauge and 19 gauge needles respectively, in 0.5-1.5mL aliquots. No coils were used. In the absence of early rebleeding, follow-up endoscopy and possible repeat therapy in both groups were performed within 3 months and periodically thereafter to eradicate GV. Eradicated GV: 1) direct endoscopy showed no visible GV or 2) residual GV were hardened on catheter palpation or exhibited minimal/ absent flow by Doppler EUS. AEs were classified as mild, moderate or severe (Cotton P et al., GIE 2012). Results: 31 patients underwent EUS-FNI (38 injecwww.giejournal.org Vol tions) and 40 received DEI (53 injections). Patient demographics and procedure findings/outcomes are listed in the Table. There was no significant difference in overall incidence of GV rebleeding after EUS-FNI (nZ2; 7.7%) and DEI (nZ9, 23.7%; 16.0% [95% CI 0-32.5] for the difference in rebleeding rate between the treatment groups). Early GV rebleeding occurred in both EUS-FNI patients and 6 of 9 DEI patients. Recurrent all-cause GI bleeding was higher in DEI group (57.9 vs. 22.6%, pZ0.004). Overall AEs were significantly higher in EUS-FNI group (47.4 vs. 13.2%, p!0.001), however the incidence of moderate/severe AEs (2 PEs, 2 splenic infarcts in EUS-FNI; 4 bleeding during injection in DEI) were similar. Conclusions: CYA injection of GV by both endoscopic and EUS approaches appear to be safe and effective with similar high treatment success rates. Both techniques may lead to rare, potentially serious AEs. Further studies are needed to determine the long-term impact of EUS-FNI in the treatment of GVs. Comparison of FNI and DEI groups ume 81, No. 5S : 2015 G EUS (n[31) ASTROINTESTI DEI (n[40) NAL ENDOSCOPY p-value Age (years) Median (IQR) 58 (46-67) 57 (52.5-60) 0.885 Gender (n, %) Female 14 (45.2) 11 (27.5) 0.122 Etiology of GV (n, %) Cirrhosis 26 (83.9) 38 (95.0) 0.227 Other 5 (16.1) 2 (5.0) Etiology of cirrhosis (n, %) Hepatitis C 9 (34.6) 12 (31.6) 0.920 Alcohol 5 (19.2) 8 (21.1) NASH/Cryptogenic 8 (30.8) 14 (36.8) Other 4 (15.4) 4 (10.5) MELD Median (IQR) 13 (9-15) 16.5 (12-22) 0.024 Reason for eradication (n, %) Primary prophylaxis 5 (16.1) 2 (5.0) 0.227 Secondary prophylaxis Active bleeding 1 (3.2) 5 (12.5) Stigmata 10 (32.3) 25 (62.5) GV type (n, %) IGV1 15 (48.4) 3 (7.5) !0.001 GOV1 2 (6.5) 6 (15.0) GOV2 14 (45.2) 30 (75.0) Largest GV size (mm) Median (IQR) 10 (7-13) 10 (10-12) 0.144 CYA volume injected (mL) Median (IQR) 2 (1.5-3) 3 (3-3) !0.001 No. of sessions for eradication 1 24 (77.4) 30 (75.0) 0.346 2/3 7 (22.6) 10 (25.0) Follow-up (days) Median (IQR) 238 (95-378) 362 (110.5-946.5) 0.123 GV rebleed (n, %) Overall 2 (7.7) 9 (23.7) 0.176 Early 2 (7.7) 6 (15.8) Late 0 3 (7.9) All cause GI bleed (n, %) Overall 7 (22.6) 22 (57.9) 0.004 Early 5 (16.1) 10 (26.3) Late 2 (6.5) 12 (31.6) Adverse events (n, %) Overall 18 (47.4) 7 (13.2) !0.001 Mild 14 (36.8) 3 (5.7) 0.156 Moderate/Severe 4 (10.5) 4 (7.5) Mo1486 The Diagnostic Utility of Endoscopic Ultrasonography in Assessing the Depth of Tumor Invasion in Early Gastric Cancer Fang Yao*, Aiming Yang, Dongsheng Wu, Xi Wu, Tao Guo, Weixun Zhou, Xinghua Lu Gastroenterology, Peking Union Medical College Hospital, Beijing, China; Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China Objective: To evaluate the role of endoscopic ultrasonography (EUS) in assessing the depth of tumor invasion in early gastric cancerand and to analyze the factors affecting the accuracy of EUS. Methods: This retrospective study enrolled 59 cases of histologically confirmed early gastric cancer who received pre-treatment EUS for