IDEN 2013 / 12 th KJSGE

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3 Poster Presentation Abstracts PUG-01 Endoscopic Surveillance Can Increase the Chance of Resectability and Endoscopic Treatment in Gastric Cancer Ji Yong Ahn, Hwoon-yong Jung, Ji Young Choi, Jeong Hoon Lee, Kwi-sook Choi, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee and Jin-ho Kim Department of Gastroenterology, University of Ulsan College of Medicine, Seoul, Korea Background / aims: Little is known about the effects of periodic endoscopic screening before detection of primary gastric cancer on clinical outcomes in endoscopically resected patients. We therefore compared clinical outcomes in patients who did and did not undergo endoscopy before diagnosis. Methods: Between January 2009 and November 2011, 769 patients (507 men, mean age 60.1±11.7 years) were referred to Asan Medical Center after diagnosis of gastric cancer at another hospital. Clinical outcomes were compared in patients who had (n=512) and had not (n=257) undergone endoscopic screening before diagnosis of gastric cancer. Factors affecting tumor resectability and the possibility of endoscopic resection were analyzed. Results: In the non-examined group, 225 patients (87.5%) had resectable gastric cancers and were treated surgically (n=151, 67.1%) or by endoscopic resection (n=74, 32.9%). In the examined group, 493 patients (96.3%) had resectable tumors and were resected surgically (n=243, 49.3%) or endoscopically (n=250, 50.7%). Multivariate analysis showed that initial symptoms, lack of endoscopic screening, and lower serum albumin concentration were independently associated with tumor unresectability. Of the 718 patients with resectable tumors, 394 underwent surgery and 324 underwent endoscopic resection. Multivariate analysis showed that older age, lack of initial symptoms, 1 year interval between endoscopy and tumor detection, and higher serum albumin were independently associated with endoscopic resection. Conclusions: Previous endoscopy, especially in asymptomatic patients with proper nutritional status, can increase gastric cancer resectability. Moreover, a 1 year interval from endoscopic examination can increase the likelihood of less invasive endoscopic resection. Keywords: Endoscopy, gastric cancer, surveillance PUG-02 Serum Pepsinogen Levels and the Status of Helicobacter Pylori Infection in Predicting the Cell Types of Gastric Neoplasm Hong Seok Choi, Sun-young Lee, Jeong Hwan Kim, In-kyung Sung, Hyung Seok Park, Chan Sup Shim, Choon Jo Jin and Yong Hwang Internal Medicine, Konkuk University School of Medicine, Seoul, Korea Background / aims: A combination of serum PG levels and Helicobacter pylori serology are used as a biomarker strategy for detection of individuals at increased risk of gastric neoplasm based on Correa s hypothesis. We aimed to uncover whether this combination method could predict the risk and cell type of gastric neoplasm. Methods: This study was based on the data of 2428 asymptomatic Korean adults who underwent serum PG tests, H. pylori serology, and esophagogastroduodenoscopy (EGD) on the same day at our center. Subjects who had gastric surgery, with extragastric malignancy were excluded from the analysis (n=337). Definite diagnosis for gastric corpus atrophy was given when PG I/II ratio was less than 3, PG I level was less than 70 ng/ml, and the EGD finding showed chronic atrophic gastritis. Results: Of 2031 subjects, 11 subjects were diagnosed as gastric neoplasm incidentally (Table 1). Of 792 atrophy(-)/h. pylori(-) subjects, 1 poorly cohesive carcinoma and 2 adenomas with high-grade dysplasia were found (0.379%). Of 1016 atrophy(-)/h. pylori(+) subjects, 2 adenocarcinoma and 2 adenomas with low-grade dysplasia were found (0.393%). Of 210 atrophy(+)/h. pylori(+) subjects, 1 adenocarcinoma and 2 adenomas with low-grade dysplasia were found (1.429%). Of 13 atrophy(+)/h. pylori(-) subjects, 1 adenoma with low-grade dysplasia was found (7.692%). Conclusions: Incidental gastric neoplasm is most common in atrophy(+)/h. pylori(-) group followed by atrophy(+)/h. pylori(+), atrophy(-)/h. pylori(+), and atro IDEN 2013 / 12 th KJSGE 391

4 IDEN 2013 / 12 th KJSGE Table 1. Incidentally found gastric neoplasms according to the status of H. pylori infection and atrophic gastritis phy(-)/h. pylori(-) groups. Although atrophy(-)/h. pylori(-) group shows the lowest incidence, it shows most advanced histology such as poorly cohesive carcinoma and adenoma with high-grade dysplasia suggesting a rapid progression of gastric neoplasm. Keywords: Serum pepsinogen, helicobacter pylori, gastric cancer Results: After endoscopic resection, 434 lesions were diagnosed as adenomas, and 60 lesions were diagnosed as adenocarcinoma. The diameter of the lesions was 21.29±8.7mm in the adenoma group and 23.53±10.1mm in the adenocarcinoma group. On post-resection tissue biopsies, adenocarcinomas were diagnosed more frequently among depressed adenomas(20.9%) than nondepressed adenomas.(9.0%) (p<0.001, OR=2.663) Similarly, adenocarcinoma were diagnosed more frequently among adenomas with ulceration(31.2%) than without ulceration (10.8%) (p=0.002, OR=3.745). In the multivariate analysis, combined high-grade dysplasia, red discoloration were significant variables associated with carcinomas. Conclusions: Gastric adenomatous lesions with endoscopic findings such as a depressed type, red discoloration, mucosal ulceration, and high-grade dysplasia should be considered for endoscopic resection. Keywords: Gastric adenoma; Gastric adenocarcinoma; Endoscopic submucosal dissection; Endoscopic findings PUG-03 Endoscopic Findings Suggesting Adenocarcinoma of Gastric Lesions Initially Diagnosed As Adenomas by Forceps Biopsy Jae Un Lee, Jin Woong Cho, Wang Guk Oh, So Hee Yun, Moon Sik Park, Shang Hoon Han, Young Jae Lee, Gum Mo Jung, Yong Keun Cho and Ji Woong Kim Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea Background / aims: Endoscopic resections are widely implemented for the management of gastric neoplasia. But, histologic results between the forcep biopsy samples and post-endoscopic resection specimens may be different. The aim of this study was to evaluate endoscopic findings of gastric adenocarcinoma that are initially diagnosed as adenomas by forceps biopsy. Methods: We retrospectively reviewed 494 lesions diagnosed as gastric adenomas by forceps biopsy from January 2008 to June The endoscopic findings were reviewed for location, size, gross appearance, ulceration and surface color. All patients underwent endoscopic resection and we compared the difference between the biopsy results before and after endoscopic submucosal dissection(esd). PUG-04 Endoscopic Characteristics Associated with the Occurrence of Missed Synchronous Gastric Neoplasms Moon Sik Park, Jin Woong Cho, Wang Guk Oh, Jae Un Lee, So Hee Yun, Shang Hoon Han, Young Jae Lee, Gum Mo Jung, Ji Woong Kim and Yong Keun Cho Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea Background / aims: A few studies have been published on missed synchronous lesions (MSLs) after endoscopic submucosal dissection (ESD), but the data of endoscopic characteristics of MSLs are lacking. The aims of our study were to define differences between missed synchronous gastric neoplasms and unmissed gastric neoplasms, and to determine the endoscopic characteristics of MSLs after ESD. Methods: From January 2008 to June 2012, 586 patients with early gastric cancers (EGCs) or gastric adenomas who had undergone ESD were included. We compared clinicopathologic factors and endoscopic characteristics between patients with MSLs group and patients 392 IDEN 2013 / 12 th KJSGE

5 Poster Presentation Abstracts with unmissed synchronous lesions group(usls group). Results: Out of 586 patients, 60 patients (10.2%) had synchronous lesions, and 17 patients (2.9%) among them had MSLs. The MSLs were found at 6.82 months (mean) after ESD. Univariate analysis of endoscopic factors showed that MSLs were correlated to the location of lesions and tumor numbers at the time of ESD, which were a significant predictive factor for presence of MSLs by multivariate logistic regression analysis. MSLs were more frequently observed when the primary main lesions were multiple than single at the time of ESD. Furthermore, the risk of MSLs increased 4.8-fold in the multiple lesions group at the time of ESD compared to the single lesion group (29.4% vs 8.1%; p = 0.003; OR=4.801; 95% CI= ). Table1. Comparison of Caracteristics of Main Lesion Between Patients With and Without MSLs. Table 2. Multivariate Logistic Regression Analysis for Predictive Factors Associated With the Presence of Missed Synchronous Lesions Conclusions: Tumor numbers at the time of ESD could be predictive factor for the presence of MSLs after ESD. The entire stomach should be examined with particular care during esophagogastroduodenoscopy, especially when ESD of multiple gastric lesions is to be performed. Keywords: Gastric neoplasms, Endoscopic surgical procedures PUG-05 Malignant Potential of Regenerative Atypical Epithelium of Biopsied Gastric Specimen from Screening Endoscopy Changhyun Lee 1, Seon Hee Lim 1, Su Jin Chung 1, Min Jung Park 1, Min A Kim 2, Woo Ho Kim 2, Jong Pil Im 3, Sang Gyun Kim 3, Joo Sung Kim 3 and Hyun Chae Jung 3 1 Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, 2 Department of Pathology, Seoul National University Hospital, Seoul, 3 Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea Background / aims: Regenerative atypical epithelium on biopsied gastric specimen (category 2 of Vienna classification; indefinite for neoplasia/dysplasia) was sometimes found in screening upper endoscopy. The aim of this study was to evaluate clinical significance and malignant potential of regenerative atypical epithelium. Methods: We retrospectively reviewed 466 cases proven regenerative atypical epithelium on initial histology of endoscopic biopsy during health checkups at Seoul National University Hospital Healthcare System Gangnam Center between October 2003 and March Of those, 282 (60.5%) had a subsequent endoscopy and enrolled the analysis. Results: Among 282 cases, 11 cases (3.9%) were finally diagnosed as gastric dysplasia (GD); gastric cancer (n=9, 81.8%) or adenoma (n=2, 18.2%). The other 271 cases were enrolled control group. The mean age (years; 60.4±9.2 versus 51.5±10.4; p = 0.006) and the mean of smoking history (pack-year; 25.4±23.2 versus 15.9±14.8; p = 0.016) were significantly different between GD group and control group. In the multivariate analysis, age 59 years (OR 3.85, 95% CI ; p = 0.040) and smoking history 25 pack-year (OR 3.65, 95% CI ; p = 0.047) significantly increased the risk of dysplastic lesion. Distribution of sex, familial history of gastric cancer, drinking, endoscopic impression, number of taken biopsy, status of H. pylori infection were not different between two groups. Conclusions: Among the cases of regenerative atypical epithelium on initial biopsy, the rate of dysplasia was 3.9% on subsequent biopsy and the risk of dysplasia was increased with age and smoking history. Subsequent en- IDEN 2013 / 12 th KJSGE 393

6 IDEN 2013 / 12 th KJSGE doscopy with biopsies is highly recommended, particularly in old age and long-standing smoker. Keywords: Stomach neoplasm, Aged, Smoking, Gastrointestinal Endoscopy, Regenerative Atypical Epithelium PUG-06 Efficacy and Safety of Endoscopic Submucosal Dissection for Superficial Squamous Esophageal Neoplasia: a Meta-analysis Byung-wook Kim and Joon Sung Kim Internal Medicine, Incheon St Mary's Hospital, the Catholic University of Korea, Incheon, Korea Background / aims: Although, ESD has grown popular in resecting lesions in the stomach, the application of ESD to the esophagus has been limited by greater technical difficulty. An increasing number of series have recently reported the application of ESD to esophageal lesions. However, data on the efficacy and safety of esophageal ESD are still controversial. The aim of the present systemic review and meta-analysis was to evaluate the efficacy and safety of ESD for esophageal lesions. Methods: Comprehensive literature searches ( ) were performed on studies that reported ESD for the removal of esophageal neoplasia. Primary outcome measures were pooled estimates of complete resection rate and en bloc resection rate. Secondary outcome measures were pooled estimates of complication rates. Results: A total of 17 studies (15 Asian, 2 European) provided data on 865 ESD-treated lesions. The pooled estimate of complete resection rate was 89.7 % (95 % CI 85 %-93 %). The pooled estimate of en bloc resection was 96 % (95 % CI 93 %-98 %). The pooled estimates of complications of ESD such as bleeding, perforation and stenosis were 2 %, 5 %, 12 %, each. Conclusions: ESD appeared to be an extremely effective technique to achieve complete resection of esophageal neoplasia. The very low rate of complications also shows the potential safety of this approach. PUG-07 Clinical Features and Outcomes of Endoscopic Hemostasis for Gastroduodenal Ulcer Bleeding in the Elderly Itaru Yamamoto 1, Hiroki Tanaka 2, Keisuke Ishigami 1, Ayako Ito 1, Masanao Nasuno 2, Suguru Nakagaki 1, Shuji Satho 1, Haruo Shimizu 1 and Hiroyuki Kaneto 1 1 Department of Gastroenterology, Muroran City General Hospital, Muroran, Hokkaido, 2 Inflammatory Bowel Disease Center, Sapporo Kosei General Hospital, Sapporo, Hokkaido, Japan Background / aims: With an increasingly aging society, the frequency of gastroduodenal ulcer bleeding in elderly individuals has been increasing. Here we compared the clinical features of endoscopic hemostasis between elderly and younger patients. Methods: A total of 151 patients who underwent emergency endoscopy for gastroduodenal ulcer bleeding from January 2006 to December 2011 were examined. They were divided into an elderly group (90 patients; age, 70 years) and a younger group (61 patients; age, Results: The proportion of females was significantly higher in the elderly group than in the younger group (55.6% vs. 16.4%, p < 0.01), as was the proportion of patients who received nonsteroidal anti-inflammatory drugs, anticoagulant agents, and antiplatelet agents (55.2% vs. 31.1%, p = 0.01). On the other hand, the rate of H. pylori infection was lower in the elderly group than in the younger group (28% vs. 65%, p < 0.01). There were no significant differences in gastroduodenal ulcer location, hemostatic method, rebleeding rate, blood transfusion requirement, and fasting period between the two groups. Conclusions: The treatment outcome of endoscopic hemostasis was similar between the elderly and younger groups. If the general condition of a patient is good, we recommend urgent endoscopic hemostasis as the first choice of treatment for gastroduodenal ulcer bleeding in both elderly and younger individuals. Keywords: Gastroduodenal ulcer bleeding; Endoscopic hemostasis Keywords: Endoscopic submucosal dissection; Esophageal neoplasia; Meta-analysis 394 IDEN 2013 / 12 th KJSGE

7 Poster Presentation Abstracts PUG-08 Do the Risk Factors for Rebleeding Differ According to the Use of Antithrombotics? Mi Jin Hong, Sun- Young Lee, Jeong Hwan Kim, In- Kyung Sung, Hyung Seok Park, Chan Sup Shim and Choon Jo Jin Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea Background / aims: Background/Aims: Endoscopic hemostasis is the first-line treatment for upper gastrointestinal bleeding (UGIB). Although several risk factors for rebleeding have been reported, little is known in patients taking antithrombotics. The aim of this study was to uncover whether the risk factors for rebleeding differ according to the use of antithrombotics. Methods: Methods: UGIB patients who were successfully controlled by endoscopic hemostasis between August 2005 and September 2012 were included. Rebleeding was diagnosed when the lesion bled again within one month of the initial endoscopic hemostasis. Medical history including current medications was recorded. Emergency endoscopy was defined when the endoscopic hemostasis was performed beyond the routine work hours (8:30 am - 6:00 pm). Results: Of 614 UGIB patients, 138 patients (22.5%) were taking antithrombotics including 16 subjects taking dual antithrombotics. Rebleeding rate was significantly higher in patients with antithrombotics (23.9%) than without antithrombotics (16.8%, p = 0.040). In patients with antithrombotics, risk factor for rebleeding was longer procedural time for endoscopic hemostasis Figure 1. Flow chart of upper gastrointestinal bleeding (UGIB) patients who were successfully controlled by endoscopic hemostasis. (p = 0.004). In patients without antithrombotics, emergency endoscopy (p = 0.027) was related to rebleeding in addition to longer procedural time (p =0.015). Conclusions: Conclusions: The risk of rebleeding is higher in patients taking antithrombotics and those with longer procedural time. Need for emergency endoscopy is an additional risk factor for rebleeding in patients without antithrombotics (ClinicalTrials.gov ID: KCT ). Keywords: Antithrombotics, Endoscopic hemostasis, Rebleeding, Risk factor, Upper gastrointestinal bleeding PUG-09 Usefulness of Pretreatment in Transnasal Endoscopy Using Rhinoscope Kamigaki Masahiko, Sinji Watanabe, Hideki Komatu, Yoshinori Fujimoto, Ikuo Nakazawa, Yasutaka Kumei and Norio Hayashi Internal Medicine, Fukagawa Daiichi Hospital, Hokkaido, Japan Background / aims: Although transnasal endoscopy has spread rapidly as an upper gastrointestinal tract examination technique because of the reduced burden on the subjects, its pretreatment is rather more complicated than that in transoral endoscopy. Therefore we intended to improve the pretreatment of transnasal endoscopy with respect to simplicity and efficiency. Methods: We used a rhinoscope to select the nasal cavity for inserting the endoscope and then to anesthetize the selected nasal cavity by spraying 6 times(about 1.5mL) by means of Jackson type spray with 0.05% naphazoline nitrate, followed by 4% lidocaine hydrochloride (corresponding to about 0.75mg and about 60mg, respectively). It took about 2 min to finish the pretreatment, and then after about 5 min, or 8 min when the selected nasal cavity seems to be slightly narrow, endoscopic examination was set about on the left side. Results: The insertion of an endoscope into the selected nasal cavity was performed in 133 subjects who had undergone transoral endoscopy before (mean age, 65.3), and 125 subjects (94%) tolerated it safely. The responses to a questionnaire administered to the subjects IDEN 2013 / 12 th KJSGE 395

8 IDEN 2013 / 12 th KJSGE about the use of a rhinoscope, the procedure of anesthesia and nasal pain during endoscopic examination showed high rates of satisfaction. Out of 125 subjects who underwent transnasal endoscopy, 115 subjects (92%) said they preferred transnasal endoscopy at the next endoscopic examination because of less distress during endoscopic examination compared to transoral endoscopy. Conclusions: This pretreatment method of transnasal endoscopy is considered to be a simple, but efficient and safe, method. Keywords: Transnasal endoscopy, Rhinoscope, Pretreatment PUG-10 Clinical Outcomes of Endoscopic and Surgical Management for Postoperative Upper Gastrointestinal Leakage Seohyun Lee 1, Hwoon-yong Jung 1, Ji Yong Ahn 1, Jeong Hoon Lee 1, Kwi-sook Choi 1, Do Hoon Kim 1, Kee Don Choi 1, Ho June Song 1, Gin Hyug Lee 1, Jin-ho Kim 1, Beom Su Kim 2, Jeong Hwan Yook 2, Sung Tae Oh 2, Byung Sik Kim 2 and Seungbong Han 3 1 Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, 2 Surgery, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, 3 Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea Background / aims: The aim of this study was to evaluate the safety and efficacy of endoscopic therapy, an alternative and less invasive modality for the management of leakage after gastrectomy. Methods: An electronic database of 35 patients with anastomotic leaks after surgery for stomach cancer that were treated with either an endoscopic procedure or surgery between January, 2004, and March, 2012, was reviewed. The success rates and safety of both modalities was evaluated. Results: Endoscopic treatment was performed in 20 patients and surgical treatment in 15 patients. The median time interval between the primary surgery and diagnosis of leakage was 8.0 days (interquartile range, 5.0?14.0 days). Of the 20 patients with endoscopic treatment, technical success was achieved in 19 patients (95%) with resulting clinical success achieved in all of these 19 patients (100%). One patient with failed endoscopic management went on to receive surgery. There were no cases of leakage-related deaths after endoscopic treatment. Of the 15 patients with surgical treatment, five died due to sepsis, bleeding, or hospital-acquired pneumonia. For diagnosis of leakage, 17 patients from the endoscopy group underwent computed tomography (CT) scanning, which revealed leakages in three patients (17.6%) and occult leakages were subsequently defined at fluoroscopy in all 20 patients. Seven of twelve patients (58.3%) from the surgical group had leakages diagnosed by CT scan. Conclusions: Endoscopic treatment can be considered a valuable option for the management of postoperative anastomotic leakage with a high degree of technical feasibility and safety, particularly for leakages that are not excessively large. Keywords: Anastomotic leak, Endoscopy, Gastrectomy PUG-11 Usefulness of Introducer Method of Percutaneous Endoscopic Gastrostomy Using Ultrathin Transnasal Endoscopy Chul-hyun Lim 1, Hong-seok Lee 1, Han Hee Lee 1, Yoonbum Lee 1, Soon-wook Lee 1, Hyo Jun Ahn 1, Na Young Kim 1, Fisseha Tekle 2, Tae-geun Kwon 1, Jong Yul Lee 1, Myong-ki Baeg 1, Jin Su Kim 1, Yu Kyung Cho 1, Jae Myung Park 1, In Seok Lee 1, Sang Woo Kim 1, Myung-gyu Choi 1 and Kyu Yong Choi 1 1 Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea, 2 Internal Medicine, Myungsung Christian Medical Center, Addis Abeba, Ethiopia Background / aims: The introducer method of percutaneous endoscopic gastrostomy (PEG) minimizes procedure-related peristomal infection. Ultrathin transnasal endoscopy (UTE) allows the comfortable endoscopic examination of patients, with fewer adverse effects, and the endoscope can pass through a narrow esophagus or oropharynx. The aim of this study was to investigate the clinical outcomes of the introducer method of PEG with UTE. Methods: Patients who underwent introducer-method PEG with UTE between March 2009 and May 2012 were analyzed. The outcomes and complications of the 396 IDEN 2013 / 12 th KJSGE

9 Poster Presentation Abstracts patients within 180 days of gastrostomy placement were investigated. Results: Ninety-two patients (31.9% male, 67.7 ± 16.6 years old) underwent introducer-method PEG with UTE during the study period. The major indications for PEG insertion were stroke (40.4%), esophageal cancer or head and neck cancer (27.1%), and neurological disorder (14.9%). Esophageal stenosis was identified by endoscopy or imaging in 14 patients before PEG. UTE was successfully introduced through the nasal cavity in all patients. PEG was successfully inserted in 90 of the 92 patients (97.8%). Insertion of the endoscope to the stomach was impossible in two patients because head and neck cancer caused severe narrowing of the upper esophagus. There was no procedure-related peristomal infection, gastric contents leakage, or bleeding within 30 days of gastrostomy placement. Catheter displacement occurred within 30 days in eight (8.7%) patients. Catheter displacement occurred in 44 (47.8%) patients and gastric contents leakage in eight (9%) patients within 30?180 days of gastrostomy placement. Conclusions: Introducer PEG with UTE is a useful method for gastrostomy placement, with a high success rate. Keywords: Ultrathin endoscopy, Transnasal endoscopy, Percutaneous endoscopic gastrostomy, Introducer method PUG-12 Preprocedural Rabeprazole Treatment before Gastric Endoscopic Resection Myong Ki Baeg, Myung-gyu Choi, Myong Ki Baeg, Seong Jin Moon, Chul-hyun Lim, Jin Soo Kim, Yu Kyung Cho, Jae Myung Park, In Seok Lee, Sang Woo Kim and Kyu Yong Choi Division of Gastroenterology, Seoul St Mary's Hospital, Seoul, Korea Background / aims: The time for the full effect of proton pump inhibitors(ppi) to take place are reported to be 5 days. Our aim was to evaluate the benefit of starting oral PPI treatment 5 days before endoscopic submucosal dissection(esd) to prevent bleeding. Methods: This was a prospective randomized controlled trial. 120 patients who underwent ESD were randomly assigned to the PPI/placebo group. Patients were given either oral rabeprazole 20mg or placebo b.i.d for 5 days before ESD. On the morning of ESD and date after, pantoprazole 40mg was intravenously administered. Afterwards, oral rabeprazole 20mg was administered once daily. Follow-up endoscopy was performed on days 1 and 28. Intragastric ph was measured in 25 patients consenting to 48-hour ph measurement. The primary endpoint was major bleeding. The secondary endpoints were the number of exposed vessels/ulcer area and ulcer healing rate on endoscopy and intragastric ph. Results: Data for 98 patients who underwent ESD(PPI group: n=45; placebo group: n=53) were analyzed. Mean age of PPI and placebo group were 59±8.9 and 58±10 years. Major bleeding occurred in four from PPI and three from placebo group. The number of exposed ulcer vessels/ulcer area on day 1 were 0.20±0.27 in PPI and 0.36±0.41 in placebo group (p = 0.03). There were no significant differences in the ulcer healing rate. Intragastric ph over 4, 5 and 6 were 84.44%±19.32, 80.55%±22.21 and 73.8%±25.44 in PPI and 86.55%± 25.85, 85.18%±26.37 and 82.79%±27.14 in placebo group. Conclusions: Preprocedural administration of rabeprazole offers no additional benefit in preventing major bleeding after gastric ESD. Keywords: Gastric neoplasm, Endoscopic submucosal dissection, Proton pump inhibitor PUG-13 The Therapeutic Potential of Irreversible Electroporation in Stomach: Experimental Study in Rat Hyuk Soon Choi, Bora Keum, Jae Min Lee, Jong Soo Lee, Seung Han Kim, Seoung Joo Nam, Eun Sun Kim, Yeonseok Seo, Yoon Tae Jeen, Hong Sik Lee, Hoon Jai Chun, Soon Ho Um, Chang Duck Kim and Ho Sang Ryu Internal Medicine University College of Medicine, Seoul, Korea Background / aims: Irreversible electroporation (IRE) is a novel, non-thermal method of tissue ablation using short pulses of high-voltage pulse current. IRE induces the breakdown of cell homeostasis and thereby cell death. The aim of this study was to evaluate the ther- IDEN 2013 / 12 th KJSGE 397

10 IDEN 2013 / 12 th KJSGE apeutic potential of IRE in rat gastric tissue according to different electric energy. Methods: A 3-cm midline abdominal incision in Sprague-Dawley rats was made, exposing the stomach. Small incision was done on greater curvature of stomach, a set of needle electrodes were gently applies on both side of the stomach. All samples for histologic analysis and tunnel assay were got at 0hours, 10 hours, 24 hours and 48 hours after IRE application. Results: H-E staining of tissue showed extensive areas and severe cell death, which were proved by a pyknotic nucleus and eosinophilic cytoplasm near absence of cell at 10 hours after IRE ablation. Positive results of TUNEL assay were found in the ablated zone at gross assessment, indicating involvement of apoptotic cell death. After 24 and 48 hours, mucosa becomes much thinner by shedding of dead cells in the mucosa. And this result shows a morphologically intact endothelium of vessel on submucosal layer after IRE irrespective of time, indicating sparing of connective tissue. Conclusions: This study showed that IRE ablated stomach tissue very effectively through the induction of cellular apoptosis. And apoptotic area was increased according to amplified IRE electric energy without damage to adjacent structure. This study suggests the potentiality of IRE application in the treatment of gastric cancer without metastasis. dysphagia and foreign body sensation when the polyp regurgitates. And the asphyxia and laryngeal obstruction by the polyp regurgitation may cause sudden death which is the most feared complication. We describe a 51-year-old male patient with an asphyxia occurred when he had been sleeping. The patient was examined with Endoscopy and an FVP of the esophagus was notified. After diagnosing, we removed the polyp endoscopically using a polypectomy snare. After polyp excision, the patient was doing well at the 3-month follow-up without asphyxia or sleep disturbance. Keywords: Esophageal neoplasm, asphyxia, polyps, treatment Figure 1. The fibrovascular polyp went through vocal cord and obstructed air way. Keywords: Irreversible electroporation, gastric cancer PUG-14 Esophageal Fibrovascular Polyp Inducing Asphyxia Jin-seok Park, Seok Jeong, Byoung Wook Bang, Don Haeng Lee, Hyung Gil Kim, Kye Sook Kwon, Jin-woo Lee, Yong Woon Shin and Young Soo Kim Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea Contents: Fibrovascular polyps (FVPs) are benign but rare tumors of the upper digestive tract, and their course is usually indolent until reaching enormous proportions. The most common complaints include Figure 2. Histopathological examination revealed that the polypoid lesion contained vascularized loose fibrous shafts covered by squamous epithelium with acanthosis, indicative of a fibrovascular polyp 398 IDEN 2013 / 12 th KJSGE

11 Poster Presentation Abstracts PLG-01 Meta-analysis: Predictive Clinicopathologic Factors for Lymph Node Metastasis in Patients with Early Colorectal Carcinoma Ju Young Choi 1, Sung-ae Jung 1, Ki-nam Shim 1, Bora Keum 2, Jeong-sik Byeon 3, Kyu Chan Huh 4, Byung Ik Jang 5, Dong Kyung Chang 6 and Hwoon-yong Jung 3 1 Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, 2 Department of Internal Medicine University College of Medicine, Seoul, 3 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 4 Department of Internal Medicine, Konyang University College of Medicine, Daejeon, 5 Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, 6 Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Background / aims: In order to reduce the number of unnecessary additional surgical resections, more rigid criteria for radical resections or additional resections following polypectomy are required. The objective of this study is to conduct a meta-analysis to determine risk factors that may facilitate patient selection for colectomy. Methods: Eligible articles were identified by searches of PUBMED, Cochrane Library and Korean Medical Database using the terms (early colorectal carcinoma, LN metastasis, colectomy, endoscopic resection). Results: Thirteen cohort studies of 7,066 ECC patients who only underwent radical surgery have been analysed. There was a significant risk of LN metastasis when they had submucosal invasion( SM2 or 1000 μm)(or3.00, 95%CI , p=0.007). LN metastasis was noted in 12.9% with SM2 or 1000 μm submucosal invasion and 4.7% with SM1 or <1000 μm submucosal invasion. Moreover, it has been found that vascular invasion (2.70, , p<0.001), lymphatic invasion (6.91, , p<0.001), poorly differentiated tumours (8.27, , p<0.001) and tumour budding (4.59, , p<0.001) were significantly associated with LN metastasis. Furthermore, another analysis was carried out on eight cohort studies of 310 patients who underwent additional surgeries following polypectomy. The major factors identified in these studies include lymphovascular invasion on polypectomy specimens (5.47, , p<0.001) and poorly or moderately differentiated tumours (4.07, , p=0.04). Conclusions: For ECC patients with SM2 or 1000 μm submucosal invasion, vascular invasion, lymphatic invasion or tumour budding, it is deemed that a more extensive resection accompanied by a LN dissection is necessary. An additional surgical resection should be considered in patients with poorly or moderately differentiated tumours or lymphovascular invasion. Keywords: Early colorectal carcinoma; Lymph node metastasis; Endoscopic resection; Surgical resection PLG-02 The Relationship between Glucose Transporter-1 (glut-1) Expression and 18f-fdg Uptake in Colorectal Cancer Joung-ho Han Division of Gastroenterology, Department of Internal Medicine, Chungbuk National University College of Medicine, 410 Sungbong-ro Heungdeok-gu, Cheongju-si Chungbuk, Korea Background / aims: We assessed the ability of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) to diagnose lymph node and distant metastases in colorectal cancer with GLUT-1 and Vascular endothelial growth factor expression. Methods: We investigated 169 patients with the diagnosis of colorectal cancer underwent 18F-FDG PET/CT before surgical treatment. Immunohistochemistry was performed using postoperative histopathological specimens and classified core and peripheral specimens. The estimation of immunohistochemistry was conducted using scoring analysis. We investigated the relationships between maximum standardized uptake value of primary tumor (p-suvmax) and lymph nodes (LN- SUVmax) and GLUT-1 expressions/pathologic T (p-t) stage/pathologic N (p-n) stage/pathologic tumor size/ WHO classification/tumor differenciation/american Joint Committee on Cancer TNM stage (AJCC TNM stage). We analyzed the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 18F-FDG PET/CT and CT for detecting lymph node metastases. Results: SUVmax significantly correlated with GLUT-1 IDEN 2013 / 12 th KJSGE 399

12 IDEN 2013 / 12 th KJSGE expressions and p-tumor length (GLUT-1: r _ 0.475, P _ 0.001; p-tumor length: r =0.475, P _ 0.001). SUVmax of the primary tumor had a significant relationship with p-t stage, p-n stage, and VEGF expression (p-t stage: P <0.001; p-n stage: P =0.037; VEGF expression: p= 0.009). There was a statistically significant difference between GLUT-1 expression and p-t stage/vegf expression, but not p-n stage (pp-t stage: p=0.012; VEGF expression: P =0.01; p-n stage:p =0.572). VEGF expression had a significant relationship with p-t stage, but not with p-n stage (p-t stage:p_0.032; p-n stage:p_0.763). Conclusions: 18F-FDG uptake can be determined by GLUT-1 and VEGF.SUVmax would have a connection with the tumor progression and lymph node metastasis. Keywords: Colorectal cancer, 18F-FDG uptake, PET/CT, GLUT-1 PLG-03 Colorectal Adenomatous Polyps and Life Style Related Diseases Kensuke Takuma 1, Ryoichi Wada 2, Toru Mitushima 2 and Yoshinori Igarashi 1 1 Diveision of Gastroenterology and Hepatology, Department of Internal Medicine, Oho University Omori Medical Center, Tokyo, 2 Department of Digestive Organs, Kameda Medical Center Makuhari, Chiba, Japan Background / aims: Recently, colorectal tumors have increased in Japan, and some reports have investigated an association of life style. In this study, we evaluated the association between colorectal adenoma and examination outcomes of life style related diseases, and differences of risk factors between genders. Methods: A total of 2970 healthy subjects(2077 males and 893 females, mean age 51.8 years) had undergone initial colonoscopy for health examination at Kameda Medical Center Makuhari from April 2007 to March We divided them into two groups, such as 691 subjects with a pathological diagnosis of colorectal adenoma and 1812 subjects with normal colon, and evaluated association with the prevalence of colorectal adenoma by gender according to age, physical findings {abdominal girth, body mass index (BMI), systolic and diastolic blood pressure}, biochemical examination {fasting blood glucose level, hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, urinary acid}, abdominal ultrasonography (fatty liver, gallbladder stone). All data were analyzed using Mann-Whitney-U test and multiple logistic regression analysis. Results: The prevalence of colorectal adenoma was 33.1% in males and 15.7% in females (p<0.001). In males, age {odds rate (OR) =2.925}, abdominal girth (OR=1.527), systolic blood pressure (OR=1.583), HbA1c (OR=1.336) were significant association with colorectal adenoma. In females, abdominal girth (OR=9.687), BMI (OR=3.084), HbA1c (OR=4.399), fatty liver (OR=3.333) were significant association. Conclusions: Abdominal girth and glucose intolerance were associated the risk for colorectal adenoma in both genders, but age was not statistically significant in females. Dietary pattern will be confirmed by additional study. Keywords: Colorectal adenoma; Life style related disease PLG-04 A Randomized Prospective Trial Comparing Different Regimens of Oral Picosulphate and Polyethylene Glycol-based Lavage in the Preparation of Patients for Colonoscopy Seung-joo Nam, Hoon Jai Chun, Yoon Tae Jeen, Jong Soo Lee, Eun Sun Kim, Bora Keum, Hong Sik Lee, Soon Ho Um, Chang Duck Kim and Ho Sang Ryu Department of Internal Medicine University College of Medicine, Seoul, Korea Background / aims: Adequate bowel cleansing is essential for a high-quality, effective, and safe colonoscopy. There are rare reports that compare directly conventional polyethylene glycol (PEG) intake and picosulphate. The aim of this study is to compare the efficacy, safety, and tolerability of different regimens of oral picosulphate and PEG. Methods: This study involved 200 adult patients undergoing elective colonoscopy and was single-blinded prospective randomized design in tertiary-care institutions 400 IDEN 2013 / 12 th KJSGE

13 Poster Presentation Abstracts of South Korea. Patients were randomized into four groups with endoscopist was blinded to the regimen. Group A: PEG 4L at 4-6 hours before procedure on the day of the colonoscopy. Group B: PEG 2L at 6:00 PM the day before and 4-6 hours before procedure. Group C: One of 2 sachets of sodium picosulphate at 6:00 PM the day before and 4 hours before procedure. Group D: One of 3 sachets of sodium picosulphate given at 6:00 and 09:00 PM the day before and at 4 hours before procedure. Results: PEG 4L group (both split and non-split dosage) and 3 sachets of picosulphate produced better mucosal cleansing than 2 sachets of picosulphate. Side effects were more frequent in PEG 4L than picosulphate. Patients preferences were most high in picosulphate than other goups. Conclusions: Picosulphate is as effective as high-volume PEG-electrolyte solution but has superior tolerance. It has fewer adverse events and is preferred by patients. Keywords: Picosulphate, Polyethylene glycol, Colonoscopy PLG-05 Addition of Peg or Re-exam with Bisacodyl for Bowel Preparation Failure: a Prospective Study Jong Wook Kim 1, Jeong-sik Byeon 2, Sun-jin Boo 3, Ock Bae Ko 2, Jung-hye Han 2, Soo-kyung Park 2, Sang Hyoung Park 2, Dong-hoon Yang 2, Kee Wook Jung 2, Kyung-jo Kim 2, Byong Duk Ye 2, Seung-jae Myung 2, Suk-kyun Yang 2 and Jin-ho Kim 2 1 Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, 2 Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 3 Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea Background / aims: We aimed to compare bowel preparation methods after failed initial bowel preparation (BP). Methods: Patients who had BP failure for colonoscopy after routine 4L ingestion of polyethylene glycol (PEG) were prospectively enrolled from March 2008 to March Second colonoscopy was performed either on the same day after additional ingestion of 2L of PEG (group A), or a week later with routine PEG (4L) and oral bisacodyl 20 mg (group B). Multivariable analysis for poor BP on second colonoscopy was performed using logistic regression. Patients who had undergone prior major abdominal surgery or colon cancer were excluded. Results: Among the 85 patients enrolled, there were 20 cases (23.5%) of poor BP on second colonoscopy. The adequacy of PEG ingestion during the first colonoscopy among the groups A and B were similar (64.3% vs. 53.5%; p = 0.312). Multivariable adjusted odds ratio (OR) for poor BP on second colonoscopy with group B compared to group A was 0.47 (95% confidence interval [CI], ). Adequately ingested PEG during the initial colonoscopy was associated with poorer BP on second colonoscopy (OR, 3.45; 95% CI, ). The rates of patient discomfort during the second BP were similar among the groups. Conclusions: Immediate addition of 2L of PEG with second colonoscopy on the same day after failed initial BP was not superior to re-examination after one week with additional bisacodyl to 4L of PEG ingestion. Stricter low fiber intake in group B could have contributed to lower rate of poor BP in group B. Keywords: Colonoscopy; Bowel cleansing, Preparation regimen; Polyethylene glycol PLG-06 Intervention of Cap-assisted Chromoendoscopy after Colonoscopy Competency Improves the Adenoma Detection Rates in the Trainees Hong Jun Park, Hyun-soo Kim, Bo Ra Kim, So Yeon Park, Jin Heon Hong, Ki Won Jo, Ho Yoel Ryu, Il Young Lee and Yong Kwan Lee Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea Background / aims: It is important to improve ADR in learning colonoscopy. Previously we reported that technological assistance of cap-assisted panchromoendoscopy (CAP-ACE) can increased the ADR. The aim of this study was to assess whether CAP-ACE intervention after technical competency increased ADR in the colonoscopy trainees. Methods: In this prospective study, from March 2011 to February 2013, six first-year GI fellows performed 500 colonoscopies respectively. Each fellow performed standard colonoscopy (SC) in the first 150 cases, then, 6 IDEN 2013 / 12 th KJSGE 401

14 IDEN 2013 / 12 th KJSGE Results: Six first-year GI fellows participated and a total of 3,000 colonoscopy procedures were analyzed. There were no significant differences in gender, indications between the two groups. Mean withdrawal time were only 1 minute longer in CAP-ACE group. In the first 150 cases, ADR, advanced ADR, number of patients with more than 3 adenomas (NMT3As) and mean number of adenomas per patient (MNAPP) were similar. However, in the latter 350 cases, ADR, NMT3As and MNAPP were significantly increased in CAP-ACE group. On per adenoma analysis, more flat and smaller adenomas were detected in CAP-ACE group than SC group. Conclusions: After technical competency of colonoscopy, the introduction of CAP-ACE could be helpful for quality improvement in the colonoscopy training programs. Keywords: Trainee, Cap assisted, Chromoendoscopy Figure 1. In the pre-intervention period, CAP-ACE group has a tendency of high adenoma detection rate. However, ADR was significantly different after intervention. In addition, CAP-ACE group has found more adenomas after intervention. Figure 2. CAP-ACE intervention has strikingly increased the ability to find the small and flat adenomas. fellows were divided into 2 groups, which were CAP-ACE group and SC group. The 3 fellows in CAP-ACE group performed 30 procedures from the 150st case using a CAP-ACE with indigocarmine, and then, the rest 3 fellows performed additional 350 SCs. Six GI fellows made and fulfilled the colonoscopy learning protocol which includes all related parameters. PLG-07 Metachronous Colon Neoplasm after Polypectomy: a Comparison between One-staged and Two-staged Polypectomy Soo-kyung Park, Jeong-sik Byeon, Sang Hyoung Park, Jong Wook Kim, Hyo Jeong Lee, Ho-su Lee, Ji Beom Kim, Dong-hoon Yang, Kee Wook Jung, Kyung Jo Kim, Byong Duk Ye, Seung-jae Myung, Suk-kyun Yang and Jin-ho Kim and Jeong-sik Byeon Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea Background / aims: The impact of one-stage (removal of all neoplasms during diagnostic colonoscopy) vs. two-stage polypectomy (removal of all neoplasms during therapeutic colonoscopy following the initial diagnostic colonoscopy) on developing metachronous neoplasm is poorly understood. We aimed to compare one-staged and two-staged polypectomy on developing metachronous neoplasm. Methods: We reviewed the patients with colon neoplasms for whom one-stage polypectomy was done and followed by at least 1 colonoscopy (case group). The development of any metachronous neoplasm and advanced metachronous neoplasm were compared with age and sex matched (1:2) two-staged polypectomy group (control group). Results: A total of 249 patients underwent one-stage polypectomy. At the initial colonoscopy, the number of neoplasms 3 (46.6% vs. 27.3%, p<0.001) was more common in control group, and there was no difference in advanced neoplasm (36.1% vs. 30.5%, p=0.13) between two groups. During the follow up (mean 26.3±13.1 months in case group vs. 23.9±12.5 months in control group, p=0.02), 347 (46.5%) patients had any metachronous neoplasm and 33 (4.4%) patients had advanced metachronous neoplasm. In multivariate analyses, IDEN 2013 / 12 th KJSGE

15 Poster Presentation Abstracts neoplasms compared with those with <3 neoplasm was the significant risk factor in the development of any metachronous neoplasms (hazard ratio, 1.72; 95% confidence interval, , p<0.001) and advanced neoplasm was the significant risk factor in the development of any advanced metachronous neoplasms (hazard ratio, 2.33; 95% confidence interval, , p=0.01). One-staged vs. two-staged polypectomy did not affect the development of either any or advanced metachronous neoplasms. Conclusions: One-staged polypectomy showed a similar cumulative incidency of metachronous neoplasms compared with two-staged polypectomy. Keywords: Polypectomy, colon, neoplasms Results: The mean procedure time of Group A was 31.7±12.9min. Group B was 121.5±69.5min. Multivariate logistic regression analysis confirmed significant, independent factors: The mean tumor size was larger group B (42.9±15.9mm, ±SD) than group A (32.0±8.4) (p<0.05). Tumor location was not significant difference between group A (Right 18/ Left 26 ) and group B (Right 9/ Left 28). Tumor depth was not significant difference between group A (M 40, SM 4) and group B (M 32, SM 5). The complication such as bleeding (Group A, 0/44, 0%, Group B 0/37, 0%), perforation (Group A, 2/44, 4.5%, Group B 2/37, 5.4%) were not different between group A and group B. Conclusions: Tumor size was difficult factor to procedure colorectal ESD. In case of large size tumor, more caution is needed during submucosal dissection. Keywords: Colorectal ESD PLG-08 Difficult Factors of Endoscopic Submucosal Dissection for Colorectal Neoplasms Naoki Hirano, Yoshinori Igarashi and Yasukiyo Sumino Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan Background / aims: Endoscopic submucosal dissection (ESD) for colorectal neoplasms have been able to resect the whole lesion in one piece and to provide histologic information. However, this technique has disadvantages such as a long intervention time, complexity of the procedure, and higher rate complications.factors correlating with the technical difficulty of colorectal ESD are still unclear. We defined difficult colorectal ESD case as more than 60min procedure time. The present retrospective study aimed to clarify important factor related to difficult colorectal ESD. Methods: From May 2009 to December 2012 ESD was performed on consecutive 81 lesions (45 men, 36 women; mean age 68.6 years) of colorectal neoplasm, less than 60 min procedure time (44 lesions, Group A) or more than 60min procedure time (37 lesions, Group B ) and their clinical outcomes were compared. PLG-09 Comparison of Endoscopic Treatment for Small Rectal Carcinoid Tumor: Endoscopic Submucosal Dissection Versus Simplified Endoscopic Submucosal Dissection Seung Hye Jung, Young Seok Cho, Hyung Keun Kim, Sung Soo Kim and Hiun Suk Chae Internal Medicine, Uijeongbu St Mary's Hospital, the Catholic University of Korea, Uijeongbu, Korea Background / aims: Endoscopic submucosal dissection (ESD) has been used for the resection of rectal carcinoid tumor. ESD may cause longer resection time, more severe complications. The aim of this study was compare ESD with simplified ESD for the endoscopic treatment of small rectal carcinoid tumor. Methods: Between January 2010 and February 2013, we enrolled consecutive patients with rectal carcinoid tumor 10 mm or less in diameter. We compared therapeutic outcomes of the ESD group and the simplified ESD group. Simplified ESD involved initially performing ESD and used snaring as the final step of resection. Results: Thirty three lesions in 30 patients were enrolled (17 ESD cases and 16 simplified ESD cases). Both groups had similar mean tumor diameters (ESD 7.53 ± 1.94 vs. simplified ESD 6.63 ± 1.99 mm; p =0.197). Resection time was longer in the ESD group than in the simplified IDEN 2013 / 12 th KJSGE 403

16 IDEN 2013 / 12 th KJSGE ESD group (20.12 ± vs ± 3.61 min; p =0.004). Histologically complete resection rate was 88.2% (15 of 17) in the ESD group and 81.2% (13 of 16) in the simplified ESD group (p = 0.592). Suspected perforation occurred in 1 ESD patient (5.9%) and in 1 simplified ESD patient (6.3%), and both patients were successfully managed using clips. There were no delayed perforation or delayed bleeding in either group. All patients with incomplete pathologic resection showed no local recurrence or distant metastasis during the follow-up period. Conclusions: Simplified ESD is a simple and effective endoscopic treatment that compares favorably to ESD for small rectal carcinoid. Keywords: Rectal carcinoid tumor; Endoscopic submucosal dissection PLG-10 Long-term Oncologic Outcomes of Stenting As a Bridge to Surgery for Malignant Colonic Obstruction: Comparison with Emergency Surgery Ji Min Choi, Jong Pil Im, Yoo Min Han, Min Jong Lee, Young Hoon Choi, Jeehye Kwon, Dong Kee Jang, Changhyun Lee, Sang Gyun Kim, Joo Sung Kim and Hyun Chae Jung Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea Background /aims: Self-expandable metallic stents (SEMS) are now regarded as an effective and safe intervention for malignant colorectal obstruction (MCO). However, stent-related overt or silent perforations might lead to the spillage of tumor cells and result in distant metastases. We aimed to compare the long-term oncologic outcomes of SEMS insertion as a bridge to surgery with those of emergency surgery for MCO. Methods: Between June 2005 and December 2011, 60 patients who underwent elective curative resection after SEMS insertion were included in the SEMS group. The SEMS group was matched to 180 patients who underwent emergency curative surgery for MCO during the same period ( Emergency surgery [ES] group ). The clinicopathologic characteristics, recurrence-free survival (RFS), and overall survival (OS) were compared between the two groups. Results: There were no significant differences in demographics, tumor stage, location, and histology between the SEMS group and the ES group. The Median follow-up times were 30.0 months (range 3.7~70.5 months) for the SEMS group and 37.4 months (range 0.3~85.8 months) for the ES group. The proportions of patients who received postoperative adjuvant chemotherapy were comparable (SEMS Group vs. ES group, 68.3% vs. 77.8%; p = 0.21). The long-term prognosis did not significantly differ between SEMS Group and ES group in either the 5-year RFS rate (76.3% vs. 69.5%; p = 0.352) or the 5-year OS rate (97.9% vs. 95.3%; p = 0.524). Conclusions: Long-term oncologic outcomes of SEMS insertion as a bridge to surgery were comparable to those of primary curative surgery. Keywords: Stents, Emergencies, Intestinal obstruction, Colorectal neoplasms, Survival rate PLG-11 Palliative Stent for Malignant Colonic Obstruction by Extracolonic Malignancy: a Comparison with Colorectal Cancer Sung Jin Moon, Sangwoo Kim, Bo-in Lee, Chul-hyun Lim, Jin Soo Kim, Yu Kyung Cho, Jae Myung Park, In Seok Lee, Myung-gyu Choi and Kyu Yong Choi Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea Background / aims: Palliative self-expandable metal stent (SEMS) placements for colonic obstruction arising from an extracolonic malignancy (ECM) might be as useful as those for colorectal cancer (CRC), but data are limited. The purpose of this study were to investigate the success and complication rates of SEMS placement in patients with ECM and to compare the long-term clinical outcomes of ECM group with those of CRC group Methods: We reviewed the short- and long-term outcome parameters of patients treated with palliative stents for colonic obstruction by ECM (n=44) or unresectable CRC (n=53) from January 2006 to March IDEN 2013 / 12 th KJSGE

17 Poster Presentation Abstracts Results: Neither the technical success rates for SEMS placement in the ECM and CRC groups (93.2% vs. 98.1%, respectively, p = 0.326) nor the clinical success rates in the two groups differed significantly (77.3% vs. 84.9%, respectively, p = 0.433). The complications of SEMS placement also differed only slightly in the two groups (perforation: 4.8% [two cases] vs. 0%, respectively; migration: 4.8% vs. 5.8%, respectively, p = 0.343). In the aspect of long-term outcomes, although stent patency was shorter in the ECM group (p =0.015), because the overall survival of this group was also shorter (p = 0.018), it was sufficient for palliative purposes. Conclusions: Palliative stent placement was equally effective and safe for the treatment of colonic obstruction arising from ECM and from unresectable CRC. Even in cases of colonic obstruction arising from ECM, SEMS placement should be considered as a primary palliative therapy. Keywords: Extracolonic malignancy, stent, colorectal cancer, stent patency, survival PLG-12 Report on Clinical Use of Capsule Endoscopy in Korea for 10 Years Yun Jeong Lim 2, Oh Young Lee 2, Yoon Tae Jeen 2, Seong Ran Jeon 2, Dae Young Cheung 2, Jae Hee Cheon 2, Byong Duk Ye 2, Ji Hyun Kim 2, Hyun Joo Song 2, Jin Su Kim 2, Cheol Hee Park 2, Jae Hyuk Do 2, Jeong Seop Moon 2, Ki-nam Shim 2, Dong Kyung Chang 2, Jin-oh Kim 2, Hoon Jai Chun 2 and Myung Gyu Choi 2 1 Internal Medicine, Dongguk University Ilsan Hospital, Goyang, 2 Korean Gut Images Study Group,n Society of Gastrointestinal Endoscopy, Seoul, 3 Internal Medicine,, Hanyang University College of Medicine, Seoul, Korea Background / aims: Capsule endoscopy (CE) is firstline method to evaluate the small bowel since it was initiated about 10 years ago.to maximize the diagnostic yield, the entire small bowel needs to be visualized. Adequate bowel preparation is important because CE has the problem that lumen visualization is impaired by bubbles, bile etc. Capsule retention is complication. This study is aimed at the overall evaluation of indication, endoscopic findings, diagnosis, completion rate and retention through nationwide multicenter study. Methods: The twenty nine hundreds fourteen cases from twenty four hospitals had been registered in Korean capsule endoscopy registry for 10 years (October, 2002~September, 2012). Results: Mean age is 53.0 ± 17.6 years and male is predominant (61%). The most common cause of reason for CE is obscure GI bleeding (59%). On the CE finding, normal finding occupied 34% and ulcers (20%), erosions (11%), angiodysplasia (9%) are common findings. Most common CE diagnosis is small bowel tumor (9.6%) and vascular lesions (9.3%). Incomplete rate is 33%. Completion rate is significantly increasing in better bowel preparation. The quality of bowel preparation for CE was not statistically different according to various methods of preparation. Capsule retention is 3% (90/2914) and is high in small bowel tumor (5.7%) and Crohn s disease (3.4%). Children under 10 years should be cautioned because retention is very high (8.3%). Poor bowel preparation are significantly associated with retention. Conclusions: CE is valuable in the elucidating small bowel disease but, retention and incomplete rate is relatively high as compared with previous reports. Keywords: Capsule endoscopy, Small bowel disease, Bowel preparation, Retention PLG-13 Comparison of Capsule Endoscopy Reading Mode: Concern about Efficiency and Time Saving Jae Min Lee, Yoon Tae Jeen, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Hong Sik Lee, Hoon Jai Chun, Soon Ho Um, Chang Duck Kim and Ho Sang Ryu Gastroenterology University Anam Medical Center, Seoul, Korea Background / aims: Capsule endoscopy is a useful test for evaluation of the small bowel. However, capsule endoscopy is needed the substantial time for capsule reading. The aim of this study was to investigate evaluation times and false negative rates in three different reading modes to find the most appropriate mode for evaluation of capsule endoscopy. Methods: Three trainee endoscopists reviewed capsule endoscopy studies performed at our institution from IDEN 2013 / 12 th KJSGE 405

18 IDEN 2013 / 12 th KJSGE 5/2007 to 6/2012. Each trainee endoscopist read a total of 30 capsule endoscopy videos. Three endoscopists compared three different capsule endoscopic software modes: automatic view at a speed of 20 frames per second (fps) and automatic quadview at a speed of 20 fps, quickview at a speed of 4 fps. Results: The mean evaluation time using quickview was significantly shorter than with automatic view (automatic single view: 18 min 48 sec, quadview: 19 min, quickview: 2 min 7 sec). The false negative rates of ulcers, erosions were higher when reading in quickview compared with reading in automatic view. However, the detection rate of bleeding was similar when reading in quickview compared with automatic view. A theoretical advantage of quadview is a longer single frame exposure time compared with singleview. Conclusions: Quickview can be used confidently in small bowel bleeding and can be performed in a short time. However, quickview mode has a high false negative rate for the other lesions, such as ulcers or erosions. Selection among time-saving methods should be made on the basis of the clinical indication for the capsule endoscopy. Keywords: Capsule endoscopy, reading mode, Detection rate, Evaluation time PLG-14 Clinical and Endoscopic Features of Patients with Ulcerative Colitis in a Japanese Local Core Hospital Ayako Ito 1, Hiroki Tanaka 2, Keisuke Ishigami 1, Itaru Yamamoto 1, Masanao Nasuno 2, Suguru Nakagaki 1, Shuji Satoh 1, Haruo Shimizu 1 and Hiroyuki Kaneto 1 1 Department of Gastroenterology, Muroran City General Hospital, Muroran, Hokkaido, 2 Inflammatory Bowel Disease Center, Sapporo Kosei General Hospital, Sapporo, Hokkaido, Japan Background / aims: In Japan, the prevalence of ulcerative colitis (UC) is increasing rapidly, resulting in increased opportunities for diagnosis and medical treatment of UC patients in local core hospitals. However, details of Japanese UC patients visiting local core hospitals are unknown because of the small number of cases. We characterized the clinical and endoscopic features of patients with UC in a Japanese local core hospital. Methods: Retrospective data for 35 patients with UC visiting the Department of Gastroenterology, Muroran City General Hospital were collected. We compared the clinical and endoscopic features of UC patients diagnosed before 2002 with those of patients diagnosed after Results: A total 35 UC cases were treated, of which 18 were female. Their mean age at the time of publishing the study and at the time of diagnosis were 45.5 and 36.9 years, respectively. The mean duration of disease was 16.4 years. Sixteen had total colitis, 10 had left-sided colitis, and 9 had proctitis-type colitis. Although the clinical and endoscopic features were similar between UC cases diagnosed before 2002 (n = 14) and after 2003 (n = 21), the mean age at the time of diagnosis among UC cases diagnosed before 2002 (31.8 ± 14.2 years) than those diagnosed after 2003 (40.3 ± 20.3 years). Conclusions: The characteristic clinical and endoscopic features of UC cases in a Japanese local core hospital resembled those previously reported in Japan, and most showed no remarkable changes in comparison with ten years previously. However, the age at onset of UC may be increasing. Keywords: Ulcerative colitis; Characteristic clinical and endoscopic features; Japanese local core hospital PLG-15 The Usefulness of Tacrolimus in Ulcerative Colitis Shinji Sato, Hiroshi Morita, Naoki Hirano, Ken Ito, Hidenori Kurakata, Hidenari Nagai, Yasukiyo Sumino and Yoshinori Igarashi Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan Background / aims: Ulcerative colitis (UC) is an idiopathic inflammatory bowel disease characterized by a chronic relapsing/intermittent clinical course.tacrolimus has been shown to be safe and effective therapy for steroid refractory/resistant UC.Since differences in the onset of action between various agents are thought to influence the achievement and maintenance of disease re- 406 IDEN 2013 / 12 th KJSGE

19 Poster Presentation Abstracts mission, accelerated stepup therapy with tacrolimus may be useful. The aim of this study is to identify the short term benefit of one month tacrolimus administration for the treatment of moderate to severe UC. Methods: Eight patients(male 6, female2 age 40.2±8.2) with active phase, moderate to severe UC were treated with oral tacrolimus at a dose of 0.1 mg/kg body weight daily. The dosages were adapted to maintain trough whole-blood levels of 10 to 15 ng/ml to induce remission and 5 to 10 ng/ml to maintain remission. Laboratory data,activity index and endoscopic featuers were assessed to evaluate in short-term outcomes. Results: At four weeks after the initiation of tacrolimus therapy, clinical remissions were observed for three patients (37.5%) and clinical response were achieved for three patients (37.5%) and the response rate was 75%. Harf of the patients got into mucosal healing in endscopic features, and almost patients were successed to induce high trouph phase within 7 days after the initiation oftacrolimus therapy and there was no severe complications in entire period of using tacrolimus. Conclusions: Tacrolimus is a safe and effective therapy for the treatment of moderate to severe UC,although still more longer follow-up of patients and compilation of further clinical data will be necessary. Keywords: Tacrolimus,ulcerative colitis Methods: We investigated patients who were treated with infliximab for CD between January 2003 and November 2010 at the IBD Center, Sapporo Kosei General Hospital. The inclusion criteria were as follows: 1) patients who received infliximab for at least 6 months; 2) those who underwent baseline ileocolonoscopy and who had mucosal ulcerations in the terminal ileum, cecum, colon or rectum; and 3) those with baseline mucosal ulceration and who underwent follow-up ileocolonoscopy 7-30 months prior to receiving dose intensification of infliximab. Mucosal healing was defined as absence of mucosal ulceration at baseline. Results: A total of 56 patients were selected for this retrospective study. Of these, 17 were female. The mean patient age was 27.3 ± 9.6 years, and mean disease duration was 4.4 ± 5.7 years. Thirty-five patients had ileocolitis, 12 had ileitis, and 7 had colitis. Concomitant treatment with azathioprine or 6-mercaptopurine, 5-aminosalicylic acid, elemental diet therapy, and prednisolone was administered in 41, 45, 41 and 46 patients, respectively. Seven patients underwent surgery for CD. Mucosal healing was observed in 77.8% patients Conclusions: Satisfactory mucosal healing rate was achieved in patients with CD who did not require dose intensification of infliximab. Keywords: Crohn s disease; Infliximab; Mucosal healing PLG-16 Mucosal Healing Rate in Japanese Patients with Crohn s Disease Treated with Infliximab Hiroki Tanaka, Masaki Yamashita, Masanao Nasuno, Manabu Ishii, Satoshi Motoya and Akimichi Imamura Inflammatory Bowel Disease Center, Sapporo Kosei General Hospital, Sapporo, Hokkaido, Japan Background / aims: Mucosal healing is considered an important benefit of treatment with anti-tumor necrosis factor alpha for Crohn s disease (CD). However, the details of mucosal healing in Japanese patients with CD treated with infliximab remain unclear. We analyzed the mucosal healing rate in Japanese patients with CD treated with infliximab. PLG-17 Efficacy of Adalimumab in Patients with Crohn s Disease Manabu Ishii, Ken-ichi Tarumi, Tomoari Kamada, Hiroshi Matsumoto, Minoru Fujita, Yoshiyuki Yamanaka, Takahisa Murao, Motoyasu Osawa, Asami Hayashida, Nobunori Hirai, Shinya Fukushima, Yoshiki Kimura, Rui Nakato, Akiko Shiotani and Ken Haruma Gastroenterology Department of Internal Medicine, Kawasaki Medical School, Kurashiki, Japan Background / aims: In this study, we aimed to investigate the efficacy of adalimumab in Japanese patients with Crohn s disease (CD). Methods: From February 2011 to November 2011, ret- IDEN 2013 / 12 th KJSGE 407

20 IDEN 2013 / 12 th KJSGE rospective data were collected from patients with active CD (Harvey-Bradshaw index [HBI] scores, 7) who received adalimumab. A total of 10 patients with active CD were included. Each patient received adalimumab 160/80 mg at weeks 0/2, and then 40 mg adalimumab every other week. The efficacy of adalimumab was evaluated based on reduction in HBI scores. Clinical remission was defined as an HBI score of 4. In patients who underwent colonoscopy before and within 6 months of more than 3 months after the initiation of adalimumab therapy, the efficacy of adalimumab was evaluated based on reduction in Simple Endoscopic Score for Crohn s Disease (SES-CD). has a wide spectrum of clinical presentations, including acute or chronic abdominal pain, gastrointestional hemorrhage, bowel obstruction, and even bizarre clinical manifestations such as ureteric colic. So foreign body perforation represent a challenging clinical scenario. Foreign body perforations could occur in all segments of the GI tract, but tend to occur in regions of acute angulation, such as the ileocecal and rectosigmoid junctions. But perforation occurred in small bowel with negative pathologic findings has been rarely reported. So we report a case of small bowel perforation caused by fish bone, with negative surgical and pathologic findings. Results: At any observational point before 24 weeks after the initiation of adalimumab therapy, HBI scores were lower than those before the start of treatment. The remission rates at 4, 10, and 24 weeks after the start of adalimumab therapy were 50%, 40%, and 70%, respectively. Among 6 patients who underwent colonoscopy, 2 showed decreased SES-CD, while 2 others showed increased SES-CD; the SES-CD of the remaining 2 patients did not change. Conclusions: Adalimumab was effective for the induction and maintenance of clinical remission in patients with active CD. In particular, the remission rate at 24 weeks after the initiation of adalimumab therapy was higher than that immediately after the initiation of therapy. Figure 1. Computed tomography findings, showing small amount of free air with mesenteric perforation Keywords: Adalimumab, Crohn s Disease PLG-18 Peritonitis Accompanied with Small Bowel Perforation Caused by Fish Bone in Normal Person Yong Hoon Choi 1, Gyu Won Kim 1, Jung Seok Kim 1, Ha Ram Lee 1 and Chan Sup Shim 2 1 Internal Medicine, Sahm Yook Medical Center, Seoul, 2 Global Digestive Disease Center, Konkuk University Medical Center, Seoul, Korea Contents: Perforation of the GI tract by ingested foreign bodies is rare, and less than 1% of ingested foreign bodies perforate the bowel. Perforation of the GI tract Figure 2. Operative findings of small bowel perforation by fish bone, without definite obstruction or stricture. Keywords: Peritonitis; Small bowel perforation; Foreign body ingestion; Fish bone 408 IDEN 2013 / 12 th KJSGE

21 Poster Presentation Abstracts PLG-19 Resolution of Colonic Lymphangiomatosis after Polypectomy: a Case Report Young Soo Lee 1, Kyu Won Kim 1, Dong Keun Kim 1, Yong Hoon Choi 1, Dong Ju Kim 1, Hye Jae Cho 2 and Chan Sup Shim 3 1 Internal Medicine, Sahm Yook Medical Center, Seoul, 2 Pathology, Sahm Yook Medical Center, Seoul, 3 Global Digestive Disease Center, Konkuk University Medical Center, Seoul, Korea Contents: Lymphangioma is an uncommon malformation of the lymphatic system that involves a benign proliferation of the lymphatics. Cystic mass in lymphangioma is caused by obstruction or agenesis of lymphatic vessel. Lymphangioma is recognized as a benign tumor, but the proper method of its treatment has remained unsettled. As it is thought to be produced by the obstruction of lymphatic flow, one can expect it to be resolved by making a new channel or conduit to it. We have a case of colonic lymphangiomatosis that was completely resolved by a single polypectomy and several incisions. Therefore, we propose that making conduits for lymphatic drainage may be an alternative, and perhaps the optimal, method of treatment for lymphangioma. Keywords: Lymphangioma; Lymphangio- matosis; Colon; Resolution; Polypectomy PLG-20 A Case of Skull Metastasis from Colon Cancer Dong Woo Shin, Yun Jin Chung, Hyunsoo Kim, Chang Keun Park, Dae Jin Kim, Hyang Eun Seo, Jae Kwon Jung and Dong Wook Lee Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea Contents: The incidence of colon cancer in many Asian countries has been rising steadily and that is associated with increased mortality. The common sites of metastasis from colon cancer are liver, peritoneum and lung. However, metastasis to the skull is extremely rare.a 63-year-old man presented with subcutaneous bulging mass on the left scalp without focal neurologic deficit. He was already diagnosed with adenocarcinoma of the colon with multiple liver metastasis 26 months ago and received chemotherapy. Brain MRI showed a convex mass in left parieto-temporal skull that was slightly Figure 1. Colonoscopic view of colonic lymphangiomatosis. Figure 2. Resolved colonic lymphangiomatosis after polypectomy. Figure 1. MR image of skull metastasis IDEN 2013 / 12 th KJSGE 409

22 IDEN 2013 / 12 th KJSGE PPB-01 Changes in Causative Pathogens of Acute Cholangitis and Their Antimicrobial Susceptibility over a Period of 6 Years Dae Young Yun, Ho Gak Kim, Jeong Seok Kwon, Hyun Hee Kim, Hyun Sik Hwang, Jun Hyeok Choi, Jang Seok Oh, Hee Sang Jang, Jimin Han, Jin Tae Jung, Joong Goo Kwon and Eun Young Kim Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea Figure 2. Histologic findings on skull metastasis decreased signal intensity on axial T1- and T2-weighted images with heterogenous enhancement by gadolinium. The mass destructed bony structures and expanded outward to the scalp and inward to the dura not involving brain parenchyme or adjacent leptomeninges. PET-CT revealed a hypermetabolic focus suggesting distant metastasis. Needle biopsy was performed of the mass and histological examination demonstrated a moderately differentiated adenocarcinoma. Immunohistochemical stain was positive for cytokeratin 20 and CDX2 that are specific markers for metastatic adenocarcinoma. The final diagnosis is the skull metastasis from colon cancer and the patient was transferred to the department of the radiation oncology for palliative radiotherapy. We report a case of skull metastasis in a patient with colon cancer. Keywords: Skull Metastasis, Colon Cancer Background / aims: We evaluated changes of bacteria cultured from bile and blood and their antimicrobial susceptibility over six years at our institution. Methods: From Aug to Aug. 2012, medical records of patients with acute cholangitis who received biliary drainage were retrospectively reviewed. Acute cholangitis was diagnosed when one or more of the followings were present: purulent bile, WBC in bile 50/HPF, positive bile culture. Total of 1,589 cases were included. Cases were divided according to time period: group A (Aug.2006-Dec.2008) and group B (Jan Aug.2012). Cases were also divided into communityacquired cholangitis (CAC) (n=201, 12.6%) and hospital-acquired cholangitis (HAC) (n=1,388, 87.4%). Results: Of 1,589 cases with bile culture, growth of bacterium was detected in 1,513 cases (95.2%). Gram-negative bacteria were isolated in 1,422 cases (94%). Most frequently isolated Gram-negative bacteria were extended beta-lactamase (ESBL)-producing Escherichia coli (E. coli) (n=482, 33.9%), E. coli (n=211, 14.8%), Citrobacter freundii (n=110, 7.7%), Klebsiella pneumoniae (K. pneumoniae) (n=99, 7.0%), and ESBLproducing K. pneumoniae (n=90, 6.3%). In HAC group, prevalence of ESBL-producing E. coli and Citrobacter freundii was higher than in CAC (52.1 vs. 31.4%, p = 0.00; 13.5 vs. 6.9%, p = 0.002). Prevalence of Citrobacter freundii was higher group B (p = 0.000) and HAC (p = 0.001) and prevalence of ESBL-producing E. coli was higher in HAC (p = 0.000). Antimicrobial agents with high susceptibility were as follows: imipenem (95.7%), amikacin (85.3%), cefotetan (77.7%), piperacillin-tazobactam (70.3%). Conclusions: ESBL-producing E. coli is the most common pathogen in cholangitis over 6 year period. In 410 IDEN 2013 / 12 th KJSGE

23 Poster Presentation Abstracts HAC, prevalence of ESBL-producing E. coli and Citrobacter freundii is higher than in CAC. Keywords: Acute cholangitis, bile culture, antimicrobial susceptibility, antimicrobial resistance Conclusions: The current data suggested that PPLBD is safe and effective for removal of large CBD stones. Keywords: Balloon Dilation,Choledocholithiasis PPB-02 Percutaneous Papillary Large Balloon Dilation for Treatment of Large Bile-duct Stones: a Feasibility Study Gyung Eun Kim, Seok Jeong, Jee Young Han, Don Haeng Lee, Byoung Wook Bang, Jin-woo Lee, Kye Sook Kwon, Hyung Gil Kim, Yong Woon Shin and Young Soo Kim Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea Background / aims: When the access to major duodenal papilla or endoscopic retrograde cholangiopancreatography (ERCP) is failed, percutaneous transhepatic cholangioscopic lithotripsy (PTCS-L) may be useful to remove common bile duct (CBD) stones. However, the feasibility and usefulness of percutaneous transhepatic papillary large-balloon dilation (PPLBD) performed during PTCS-L for the removal of large CBD stones, is not established yet. The aim of this study was to investigate the safety and efficacy of PPLBD for the treatment of large CBD stones. Methods: Eleven patients with large CBD stones in whom the access to major papilla or ERCP had failed in a tertiary referral center between September 2011 and August 2012 were enrolled prospectively. Papillary dilation using large-bored (12-20 mm) balloon dilation catheter was performed through the percutaneous transhepatic route. We analyzed the efficacy of the stone retrieval and post-procedure complications after the procedure. Results: The success rate for the complete duct clearance was 100%. There was no patient who needs use of basket to remove the stone after PPLBD. Electrohydraulic lithotripsy was required in 2 (18.2%) patients. The median time to complete stone removal after PPLBD was 17.8 minutes. There was no any complications occurred after PPLBD. Asymptomatic hyperamylasemia did not occur in all patients. PPB-03 Development of a Swine Benign Biliary Strictrure Model Using Endobiliary Radiofrequency Ablation Seok Jeong and Don Haeng Lee Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea Background / aims: An established and reproducible animal model of benign biliary stricture (BBS) has been indispensable to develop new devices or methods for endoscopic treatment of biliary stricture. We studied how to make a porcine BBS model using endobiliary radiofrequency ablation (RFA). Methods: 14-month-old, female mini pigs (Sus scrofa), each approximately 30 kg, were used. Endoscopic retrograde cholangiography (ERC) was performed in 12 swine. The animals were allocated to three groups (100 W, 80 W, and 60 W) according to the electrical power level of RFA electrode. Endobiliary RFA was applied to the common bile duct for 60 seconds using by RFA probe which could be endoscopically inserted. ERC was repeated two and four weeks respectively after the RFA to identify BBS. After the strictures were identified, the animals were euthanized and bile duct samples were achieved to evaluate the pathologic findings. Results: BBS were verified in all animals. Cholangitis were detected on endoscopic findings of day 14 in all the animals of 3 groups, but not significant. Bile duct perforations occurred in 1 swine (n=1, 100%) for 100 W group, and 1 swine (n=7, 14.3%) for 80 W group. There was no major complication (n=4, 0%) in 60 W group. All benign strictures were proven pathologically. The pathologic findings resembled BBS in human. Conclusions: The application of endobiliary RFA with 60 W-electrical power resulted in a safe and reproducible swine model of BBS. Keywords: Catheter ablation, radiofrequency; Common bile duct; Constriction, pathologic IDEN 2013 / 12 th KJSGE 411

24 IDEN 2013 / 12 th KJSGE PPB-04 Treatment Strategy for Adenomyomatosis of the Gallbladder According to 3 Different Types Eun-ji Lee, Young Soo Moon, Tae Oh Kim, Seung Ha Park, Jong Ha Park, Nae-yun Heo, Hyung Jun Kim, Soon Il Lee and Gi Jung Jeon Department of Internal Medicine, Haeundae Paik Hospital,inje University College of Medicine, Busan, Korea Background / aims: Adenomyomatosis of gallbladder (GB) is relatively rare, benign hyperplastic condition. Correct diagnosis is sometimes difficult because overlapping features of imaging. We investigated final diagnoses in patients with different types of gallbladder adenomyomatosis by multimodality evaluation, including US, CT and EUS. Methods: A retrospective review of 16 consecutive patients with abnormal radiologic findings (focal or diffuse GB wall thickening) were included. Results: Among 16 patients, US, CT, EUS and histologic diagnosis were made. Ten patients of 16 whom adenomyomatosis was suspected underwent surgical resection. Three of them were confirmed by surgical pathology. Two patients of them had localized type adenomyomatosis and one had segmental. In one patient that was diagnosed as adenocarcinoma revealed diffuse type by surgery. Other 6 patients showed chronic cholecystitis. Their EUS findings were equivocal, 4 of them were accompanied with sludge or stone. Six patients without symptoms have only regular follow-up. Three morphological types of adenomyomatosis are described, and some patients were treated with operation. Localized type, especially adenomyoma is indication of surgery because imaging could not differentiate malignancy. Segmental type is reported to be occasionally associated with cancer risk. If patient have symptoms or gallstone, we consider surgical treatment primarily. Conclusions: Adenomyomatosis is an uncommon, benign gallbladder disease, and sometimes accurate diagnosis is difficult because of overlapping features with other conditions. Surgical resection may be indicated in symptomatic cases or an unclear diagnosis, but judicious decision making through meticulous examination is necessary. Here, we recommend treatment strategy for the management of GB adenomyomatosis. Keywords: Adenomyomatosis of gallbladder, EUS, Surgical pathology PPB-05 Efficacy of Endoscopic Pancreatic Stenting for the Pancreatic Duct Stricture from Chronic Pancreatitis Ken Ito, Takahiko Mimura, Seiichi Hara, Kensuke Takuma, Yui Kishimoto and Yoshinori Igarashi Division of Gastroenterology and Hepatorolo, Toho University, Omori Medical Center, Tokyo, Japan Background / aims: We carried out a retrospective study to evaluate the efficacy of the endoscopic treatment of pancreatic duct strictures from chronic pancreatitis. Methods: The indications for this study are the followings :a) presence of abdominal symptoms, and b) association with the pancreatic duct stricture and upstream MPD dilatation detected by diagnostic imaging. The relative indications are the followings, a) asymptomatic cases, and the presence of lithiasis in the Santorini duct or Wirsung duct with MPD dilatation. Panceratic sphincterotomy was routinely performed. After gradual dilatation, 10Fr. plastic pancreatic stent was finally inserted. The stents were replaced every 3 months, and removed if the stricture was considered to be dilated after stenting. Results: Over an eight-year period (May 2005 to December 2010), 59 patients (alcoholic in 49 patients, idiopathic in 3 patients, and others in 7 patients) were treated by EPS. Endoscopic stenting was successfully completed in 46 of 59 patients (77.9%) without any complication. Pain relief was obtained in 53 of 59 patients (89.8%). In the 13 failed cases of pancreatic stenting, 10 patients were asymptomatic, but 3 patients required surgical drainage because no improvement of pain relief. Six of 46 patients (13%) had recurrence of MPD stricture ( alcohol abuse in 2 patients, no alcohol abuse in 4 patients), and required re-stenting. Conclusions: EPS is an effective and useful procedure and useful for prevention of re-stricture in patients with 412 IDEN 2013 / 12 th KJSGE

25 Poster Presentation Abstracts benign pancreatic duct strictures from chronic pancreatitis. However, surgical drainage should be considered in EPS failed cases. Keywords: Endoscopic pancreatic stenting chronic pancreatitis PPB-06 Abdominal Compartment Syndrome in Severe Acute Pancreatitis Treated with Percutaneous Catheter Decompression Seung Ho Lee, Seon Mee Park, Joung-ho Han, Soon Man Yoon, Hee Bok Chae and Sei Jin Youn Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea Contents: Acute pancreatitis is one of the main causes of intra-abdominal hypertension (IAH). IAH contributes to multiple physiologic alterations and leads to the development of abdominal compartment syndrome (ACS) that induce multi-organ failure. We report the case of ACS in severe acute pancreatitis. A 44-year-old man who was admitted in a drunken state was diagnosed with severe acute pancreatitis. During management with excessive fluid resuscitation in an intensive care unit, drowsy mentality, respiratory acidosis, shock requiring inotrope, and oliguria developed in the condition of tensely distended abdomen. Under presumptive diagnosis of ACS, abdominal decompression via percutaneous catheter was performed immediately. Figure 1. After a percutaneous drainage catheter was inserted, the patient s intra-abdominal pressure (IAP) was decreased. Consequently, respiratory acidosis, oliguria and confused mental status resolved. High abdominal pressure was detected via percutaneous drainage catheters. After abdominal decompression, multi-organ failure was reversed. We present a case of ACS managed successfully with percutaneous catheter decompression. Keywords: Severe acute pancreatitis, Intra-abdominal hypertension, Abdominal compartment syndrome, Percutaneous catheter decompression PPB-07 The Effect of Sustained Use of Platelet Aggregation Inhibitors on Post-endoscopic Sphincterotomy Bleeding Sang Hyub Lee 1, Min Geun Lee 2, Seung June Lee 3, Yoon Suk Lee 3, Jin Hyeok Hwang 3, Jaihwan Kim 4, Ban Seok Lee 5 and Byung Hyo Cha 5 1 Internal Medicine, Seoul National University Hospital, Seoul, 2 Internal Medicine, Hanmaeum Hospital, Jeju, 3 Internal Medicine, Seoul National University Bundang Hospital, Seongnam, 4 Internal Medicine, Kangwon National University School of Medicine, Chuncheon, 5 Internal Medicine, Cheju Halla General Hospital, Jeju, Korea Background / aims: The effect of platelet aggregation inhibitors (PAI) on post-endoscopic sphincterotomy (EST) bleeding in patients who cannot discontinue PAI for sufficient time has not been identified.to evaluate the effect of PAI on post-est bleeding,this study was performed. Methods: In a single, tertiary-care referral center, this retrospective analysis for the incidence, type, and severity of post-est bleeding according to the sustained use of PAI was performed. A total of 132 patients who had sustained PAI therapy until EST or had it interrupted for less than 7 days prior to EST was analyzed (Figure 1). Results: Among 132 patients with continued use of PAI, 49 patients were sustained users of PAI until EST due to the high risk of thromboembolism (n=21), acute septic cholangitis (n=20), or combined problems (n=8). The clinical characteristics were not different according to the sustained use of PAI. There was no significant difference regarding the bleeding rate and severity according to sustained or non-sustained use (p =.071 and p =.086, respectively). However, the type of post-est IDEN 2013 / 12 th KJSGE 413

26 IDEN 2013 / 12 th KJSGE bleeding differed among the groups (p =.038). Post- EST delayed bleeding more frequent in sustained PAI users than in non-sustained PAI users (7/49, 14.3% vs. 2/83, 2.4%, p =.013). Furthermore, multivariate analysis showed that post-est delayed bleeding was significantly associated with the sustained use of PAI (OR 6.750; 95% CI, ; p =.020) in continuation group. Billroth II gastrectomy, the success rate of endoscopic retrograde cholangiopancreaticography (ERCP) is low and complication rate is high. It may be important for ERCP endoscopists to identify the type of gastroenteric anastomosis in patients with previous subtotal gastrectomy before the start of the ERCP, particularly in biliary emergencies. The aim of this study was to evaluate whether ERCP endoscopists can distinguish the type of gastroenteric anastomosis in patients with previous subtotal gastrectomy based on CT findings. Methods: A total of 70 abdominal CT scans from patients who had undergone subtotal gastrectomy (n=36, Billroth I; n=34, Billroth II) were selected for the study. Images were reviewed by 3 ERCP endoscopists blinded to clinical data. The endoscopists were asked to provide the most probable type of anastomosis. The sensitivity and specificity were analyzed for identifying Billroth II gastrectomy. Figure 1. Among a total of 762 patients undergoing EST, 132 patients were analyzed. Conclusions: Sustained use of PAI until EST might increase the risk of delayed bleeding. Keywords: Platelet aggregation inhibitors, Gastrointestinal hemorrahge, Endoscopic sphincterotomy PPB-08 Value of Computed Tomography for Endoscopic Retrograde Cholangiopancreaticography Endoscopists to Identify the Type of Anastomosis in Patients with Previous Subtotal Gastrectomy Results: The sensitivity, specificity and interobserver agreement of CT findings to identify the type of anastomosis by ERCP endoscopists were 100%, 97% and 0.971, respectively. The key CT features of distinguishing Billroth II gastrectomy from Billroth I gastrectomy were 1) loss of continuity between the remnant stomach and duodenum; 2) less distended duodenal bulb; 3) the presence of closed duodenal stump with surgical staples and 4) presence of continuity between the remnant stomach and jejunum. Conclusions: ERCP endoscopists had the ability of distinguishing the type of anastomosis in patients with previous gastrectomy based on CT findings. Careful evaluation of abdominal CT before emergency procedure may identify the type of anastomosis. Keywords: Subtotal gastrectomy; Endoscopic retrograde cholangiopancreaticography; Computed tomography Jung Sun An 1, Sung-hoon Moon 1, Seung Yeon Chun 1, Jong Hyeok Kim 1, Dong Hee Koh 2 and Jae Hoon Yoon 3 1 Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, 2 Department of Internal Medicine, Dongtan University Sacred Heart Hospital, Dongtan, 3 Department of Internal Medicine, Chuncheon University Sacred Heart Hospital, Chuncheon, Korea Background / aims: In patients who had previous 414 IDEN 2013 / 12 th KJSGE

27 Poster Presentation Abstracts POT-01 Feasibility of Endoscopic Submucosal Dissection for Type I Gastric Carcinoids Compared with Endoscopic Submucosal Resection Hyung Hun Kim 1, Ji Hyung Kim 2, Gwang Ha Kim 3 and Myung-kyu Choi 1 1 Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, 2 Internal Medicine, Inje University College of Medicine, Busan, 3 Internal Medicine, Pusan National University School of Medicine, Bsuan, Korea Background / aims: Conventional endoscopic submucosal resection (EMR) of carcinoid tumors is often associated with involvement of the resection margin, which necessitates further intervention. Endoscopic submucosal dissection (ESD) is a novel technique for the removal of carcinoid tumors. The aim of the present study was to compare the clinical usefulness of ESD with that of EMR for the complete resection of gastric carcinoid tumors. Methods: Between January 2001 and October 2010, a total of 41 patients with 54 type I gastric carcinoid tumors that were estimated to be 10 mm or less in diameter and that were resected either using ESD or EMR were investigated for this study. The complete resection rate and complications associated with these two procedures were analyzed. Results: Among the 54 lesions, 36 were resected using EMR, and 18 lesions were resected using ESD. There were no significant differences between the EMR and ESD groups in terms of the location or the size of the tumors. The overall ESD complete resection rate was higher than that of EMR (88.9% vs. 75.0%, respectively, p = 0.301). A lower vertical margin involvement rate was obtained when ESD was performed compared to that when EMR was performed (5.6% vs. 16.7%, respectively, p = 0.403). However, there was no statistical difference. The complication rate was not significantly different between the two groups. Conclusions: ESD showed higher complete resection rate, especially in vertical margin despite lack of statistical significance. Keywords: Carcinoid tumor; Endoscopic submucosal resection; Ligation device POT-02 Generation of Pain after Endoscopic Submucosal Dissection for Early Gastric Neoplasms Da Hyun Jung, Hyojin Park, Jie-hyun Kim and Young Hoon Youn Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea Background / aims: ESD has been widely used as curable local treatment for EGC. However, there is rare data about pain which might lower compliance. Thus, we investigated incidence and risk factors associated with pain after ESD. Methods: This was a prospective, randomized control study. Between 2011 and 2012, 78 patients were diagnosed as EGC and underwent ESD at Gangnam Severance Hospital. Among them, 20 patients were received test with 150 ml of 0.1 mol/l hydrochloric acid-infusion for investigating mechanisms of pain after ESD. The severity of symptoms were assessed by a 10 cm visual analogue scale at 3 hours and day after ESD and during acid-infusion. To investigate effect of acid suppression on pain after ESD, subjects were randomized to receive PPI before or after ESD. Results: The incidence of pain after ESD was 50.4 %. The male, older age, lower location, larger size and longer time tended to be associated with pain after ESD. Among 20 patients who were received acid-infusion, subjects developing dyspeptic symptoms was 50 %. The subjects experiencing pain after ESD was significantly greater in patients with dyspeptic symptoms than without by acid infusion. The patients who were generated pain were significantly more in group which was received PPI after ESD than before ESD. Conclusions: The pain after ESD was significantly greater in patients who were developed dyspeptic symptoms by acid-infusion. The subjects with pain after ESD were significantly lower when gastric acid was suppressed, suggesting that hypersensitivity to acid is one of the important mechanisms of pain in ESD patients. Keywords: Pain, Early Gastric Cancer, Endoscopic Submucosal Dissection IDEN 2013 / 12 th KJSGE 415

28 IDEN 2013 / 12 th KJSGE POT-03 Three Cases of Delayed Perforation after Endoscopic Submucosal Dissection Takafumi Yano 1, Satoshi Tanabe 2, Masao Araki1, Kenji Ishido 2, Mizutomo Azuma 2, Toru Sasaki 2, Katsuhiko Higuchi 2, Wasaburo Koizumi 2 and Tetsuo Mikami 3 1 Department of Gastroenterology, Sagamihara Kyodo Hospital, Sagamihara City, 2 Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara City, 3 Department of Pathology, Kitasato University School of Medicine, Sagamihara City, Japan Contents: Background: The incidence of delayed perforation after endoscopic submucosal dissection (ESD) is low, but this procedural accident requires extreme caution and surgical intervention. As of March 2011, delayed perforation occurred in 3 (0.2%) of 1321 patients who underwent ESD for gastric tumors in our hospital. We report the clinical characteristics of these patients. Case patients: Patient 1 was an 89-year-old man with a superficial and slightly depressed type (0-IIc) lesion measuring 70 mm in diameter, arising in the gastric angle. An area measuring 100 mm was resected using an insulation-tipped (IT) knife. In the early morning of day 2 after ESD, free air was detected on abdominal computed tomography (CT). An emergency laparotomy was performed on the same day. Patient 2 was a 74-year-old man with two adjacent 0-IIc lesions arising in the anterior and posterior walls of the greater curvature of the gastric angle. ESD was performed with an IT knife-2. Areas measuring 47 mm and 43 mm were resected. The cut surfaces were fused together, creating one ulcer-like surface. Free air was detected on abdominal CT on the day after ESD. An emergency laparotomy was performed on the same day. Patient 3 was a 63-year-old man who had undergone distal gastrectomy with Billroth I reconstruction. A 0-IIa lesion was found in the posterior wall of the greater curvature of the residual stomach. An area measuring 30 mm 24 mm was resected with an IT knife-2. Nausea developed during the night of the day of ESD. In the early morning of the day after ESD, abdominal CT revealed free air, and an emergency laparotomy was performed on the same day. A perforation was found at the site of treatment. Conclusions: Patients should be carefully followed up after ESD, even if there is no evidence of perforation during or immediately after the procedure. Keywords: Delayed Perforation POT-04 Hyaluronic Acid Solution Injection to Control Bleeding from a Sclerotic Ulcer Base or Cancer Hyung Hun Kim, Chul-hyun Lim, Jae Myung Park and Myung-gyu Choi Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea Background / aims: Conventional techniques to control bleeding from sclerotic tissue, such as endoscopic clippings, are not always successful. Hyaluronic acid solution injection can be an additional endoscopic modality for controlling difficult cases when other techniques failed. We evaluated the feasibility of hyaluronic acid solution injection in various bleeding cases retrospectively. Methods: We evaluated 12 cases which we used Hyaluronic acid solution injection for stop bleeding. Hyaluronic acid solution injection was performed as follows: (1) generation of 20 cc of a 0.2% hyaluronic acid solution by mixing hyaluronic acid and saline; (2) precise identification of the bleeding focus; (3) injection of 5 cc of hyaluronic acid solution into each point surrounding the bleeding focus; and (4) the lesion was washed and checked for further bleeding. Cessation of bleeding was measured based on clinical findings or endoscopic examination. Results: Immediately following Hyaluronic acid solution injection, bleeding was controlled in 11 out of 12 cases. There was no evidence of renewed bleeding and proved complete healing was found in 11 cases, although we were unable to do follow-up endoscopy in all cases. Conclusions: : Hyaluronic acid solution injection is a simple and efficient method for controlling bleeding at the site of a sclerotic ulcer base, so it needs to be considered as a next step before deciding radiologic intervention or surgery. Keywords: Hyaluronic acid; Hemorrhage; Ulcer; Neoplasms 416 IDEN 2013 / 12 th KJSGE

29 Poster Presentation Abstracts POT-05 Tumor Localization Using Magnetic Marking Clip during Laparoscopic Surgery for Gastric Submucosal Tumor : a Pilot Study Jong Soo Lee, Hoon Jai Chun, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yoon Tae Jeen, Hong Sik Lee, Chang Duck Kim, Seung Han Kim, Jae Min Lee, Sun Young Yim, Seok Bae Yoon and Tae Jung Yun Division of Gastroenterology and Hepatology University College of Medicine, Seoul, Korea Background / aims: It is difficult to locate a tumor simply and correctly during laparoscopic surgery for submucosal tumor (SMT). Various methods such as intraoperative sonography, intraoperative endoscopy, etc, are performed in localization gastrointestinal tumor for laparoscopic surgery. However there are limitations of methods, such as discomfort for surgeon, complexity. To overcome these limitation, we devised a simple marking clip with magnet to locate a tumor. Methods: This study enrolled 11 patients undergoing laparoscopic wedge resection for SMT. We devised 10mm sized ring type magnet (outdiameter:d10mm, indiameter:4mm, thickness:3mm, maximal magnetic force:2660g), which was coated with silicon and fixed to endoclip using 3 0 nylon. A magnetic marking clip was applied on the center of lesion during preoperative esophagogastroduodenoscopy. During surgery, magnetic body hanged with long thread which was inserted through laparoscopic trocar, was used to find intragastric lesion which marked by magnetic clip. We analized tumor detection rate, detection time, proximal & distal margin from lesion and complication. Results: Magnetic marking clips were successfully detected in all 11 patients. The time required for detection ranged from 20 to 85 sec. The resected margin from lesion ranged from 5 to 30 mm. 8/12 of pathology was confirmed GIST, 3/12 was leiomyoma, 1/12 was schwanoma. None of our patients experienced complication s from this marking technique. Conclusions: Magnetic marking clip method was simple and convenient for surgeon, and showed good results for accuracy of tumor localization, and detection rate. Therefore the magnetic marking clip method may be useful for tumor site detection during laparoscopic SMT wedge resection. Keywords: Endoclip; Magnet; Laparoscopic surgery POT-06 Delayed Flumazenil Injection after Endoscopic Sedation Increases Patient Satisfaction Compared to Immediate Flumazenil Injection Chun Ho Shin, Byoung Wook Bang, Hyung Gil Kim, Kye Sook Kwon, Yong Woon Shin and Hyun Jung Chung Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea Background / aims: Flumazenil was administered after the completion of endoscopy under sedation to reduce recovery time and increase patient safety. We evaluated patient satisfaction after endoscopy with sedation according to the timing of post-procedural flumazenil injection. Methods: Two hundred subjects undergoing concurrent colonoscopy and upper endoscopy while sedated with midazolam and meperidine were enrolled in our investigation. We randomly administered 0.3 mg flumazenil either immediately or 15 minutes after the endoscopic procedure. Post-procedural questionnaire and next-day telephone interview were conducted to assess patient satisfaction. Results: Flumazenil injection timing did not affect the duration of time spent in the recovery room when comparing the two groups of patients. However, subjects in the 15-minute injection group were more satisfied with undergoing endoscopy under sedation than patients in the immediate injection group according to the post-procedural survey (p = 0.019). However, no difference in overall satisfaction, memory, or willingness to undergo future endoscopy was observed between the two groups when the telephone survey was conducted the following day. Conclusions: This study showed that delayed flumazenil injection after endoscopic sedation increased patient satisfaction without prolonging recovery times even though the benefit of delayed flumazenil injection did not persist into the following day. Keywords: Colonoscopy; Flumazenil; Midazolam; Patient satisfaction IDEN 2013 / 12 th KJSGE 417

30 IDEN 2013 / 12 th KJSGE POT-07 Endoscopic Magnetic Marking Technique for Laparoscopic Colon Tumor Operation : a Pilot Study Seung Han Kim, Hoon Jai Chun, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yoon Tae Jeen, Hong Sik Lee, Chang Duck Kim, Jae Min Lee, Seung Joo Nam, Jong Soo Lee, Sun Young Yim, Seok Bae Yoon and Tae Jung Yun Division of Gastroenterology and Hepatology, University College of Medicine, Seoul, Korea Background / aims: It is difficult to locate correctly and safely a colorectal tumor for laparoscopic surgery. Tattooing is simple, so generally used for localization of colorectal tumor during laparoscopic surgery. However there are limitations, such as incorrect tumor localization due to spread of ink, risk of bowel perforation. To overcome these limitations, we devised a simple magnetic marking technique. Methods: This study enrolled 12 patients undergoing laparoscopic surgery for early colorectal cancer. We devised 10mm sized ring type magnet (outdiameter:10mm, indiameter:4mm, thickness:3mm, maximal magnetic force:2660g) which was coated with silicon, and we tied loop using 3-0 nylon. We inserted the marking magnet near lesion with biopsy forcep, and then clipped magnet on target through loop of magnet. A magnetic marking clip was applied on the distal side of lesion during preoperative colonoscopy. During surgery, another magnetic body hanged with long thread which was inserted through laparoscopic trocar, was used to find out the lesion that was marked by magnetic clipping. We analyzed detection rate, detection time, resection margin length from lesion and complication. Results: Magnetic marking clips were successfully detected in all 12 patients. The time required for detection ranged from 10 to 35 sec. The resection margin from lesion ranged from 40 to 50mm. None of our patients experienced complication s from this marking technique. Conclusions: Magnetic marking technique was simole and showed good result for accuracy of tumor localization without complication. Therefore, the magnetic marking clip method may be useful for colorectal tumor detection during laparoscopic surgery. Keywords: Endoclip; Magnet; Laparoscopic surgery POT-08 Clinical Efficacy of Various Diagnostic Tests in the Small Bowel Tumors and Clinical Features of Missed Small Bowel Tumors by Capsule Endoscopy Jung Wan Han 1, Hyun Joo Jang 1, Sung Noh Hong 2, Seong Ran Jeon 3, Hwang Choi 4, Soo Jung Park 5, Dong Kyung Chang 2, Small Intestine Research (SIR) Group of the Korean Association for the Study of Intestinal Diseases 1 Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, 2 Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 3 Soonchunhyang University Hospital, Soonchunhyang University School of Medicine, Seoul, Korea, 4 Incheon St. Mary s Hospital, Catholic University School of Medicine, Incheon, 5YonSei University College of Medicine, Seoul, Korea Background / aims: Primary small bowel neoplasms are rare but increasing in prevalence and are associated with significant morbidity. Capsule endoscopy (CE) is widely accepted as the preferred diagnostic test in the evaluation of small bowel diseases. However, small bowel tumors (SBT) are sometimes missed by CE. The purpose of this study is to evaluate the diagnostic yields of various diagnostic tools such as CT, small bowel follow through (SBFT), and CE and to evaluate the clinical features of missed SBT by CE. Methods: This study is a multicenter, retrospective study of KASID SIR group with the 79 patients of SBTs diagnosed by surgery and enteroscopy with biopsies between March 2004 and December Demographic characteristics, clinical presentation, results of diagnostic tests and characteristics of tumors were evaluated for each patient. Results: The most common symptoms of SBTs were bleeding (43%, 29 overt and 5 occult bleeding) and abdominal pain (13.9%). Diagnostic yields of various diagnostic tests were as follow: CT detected 55.8%(38/68) of definitive SBT, SBFT 46.1%(18/39) of definitive SBT, CE 83.3%(45/54) of definitive SBT. The sensitivity of diagnostic tests was as follow: CT was 40.4%, SBFT 43.9%, CE 79.6%. Nine patients (16.7%) which were suspicious(2) and negative(7) findings of CE were finally diagnosed as GISTs(4), adenocarcinoma(1), inflammatory fibroid polyp(1), and small polyps(3), which were located in proximal jejunum(5), mid jejunum(1), distal jejunum(1) and proximal ileum (2). 418 IDEN 2013 / 12 th KJSGE

31 Poster Presentation Abstracts Conclusions: CE can more effectively detect SBTs than radiologic diagnostic tests. However CE can miss some significant tumors located mainly in proximal jejunum. Keywords: Small bowel tumor, Capsule endoscopy POT-09 Endoscopy was performed 15 min after infusion. Grade of residual food was rated as follows; G0 no residual food, G1 a small amount of residual food, G2 a moderate amount of residual food, G3 a moderate amount of residual food which hinders observation of the entire surface even with body rolling, G4 a great amount of residual food for which endoscopic observation is impossible. Premedication of Erythromycin Improves Endoscopic Mucosal Visualization in Patients with Subtotal Gastrectomy Byoung Yun Jun 1, Myung-gyu Choi 1, Fisseha Tekle 2, Jong Yul Lee 1, Myong-ki Baeg 1, Sung Jin Moon 1, Chul-hyun Lim 1, Jin Su Kim 1, Yu Kyung Cho 1, In Seok Lee 1, Sang Woo Kim 1 and Kyu Yong Choi 1 1 Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea, 2 Department of Internal Medicine, Myungsung Christian Medical Center, Addis Ababa, Ethiopia Background / aims: Food residues in remnant stomach after subtotal gastrectomy (STG) interfere endoscopic observation. We investigated whether intravenous erythromycin improves gastric mucosa visualization in patients with STG. Figure 1. The percentage of patients with good visibility in the placebo group and in the erythromycin group Methods: Design: Double-blinded, placebo-controlled, randomized trial. Setting: Tertiary referral center. Participants: Patients who received STG with complete resection (Stage; T1-2N0M0) were included. Exclusion criteria were DM, neurologic disease, myopathy, recent viral enteritis history, concomitant therapy influencing GI motility and severe co-morbidity. Intervention: Patients were assigned randomly to receive either erythromycin (125 mg in normal saline 50 cc) or placebo. Figure 2. The grade of food stasis against the time elapsed after surgery in the placebo group and in the erythromycin group. Results: When good visibility was defined as G0+G1, visibility was significantly better in EM group (61%+19%) compared with placebo group (38%+12%, p<0.001). However, this effect was not seen in patients within 6 months after gastrectomy. Risk factor for food stasis in placebo group (N = 58) was food stasis at last endoscopy. Factor predicting EM response in EM group (N = 56) was only elapsed time after surgery. Adverse Effects included 11 (19.7%) nausea and 1 (1.8%) vomiting in EM group IDEN 2013 / 12 th KJSGE 419

32 IDEN 2013 / 12 th KJSGE and 3 (5.2%) in placebo group. However, they were transient and tolerable. Conclusions: Premedication of erythromycin improves mucosal visualization during endoscopy in patients with STG. Keywords: Gastrectomy; Gastrointestinal motility; Gastroparesis; Premedication; Erythromycin POT-10 An Adequate Level of Training for Technically Competent Endoscopic Mucosal Resection of Colorectal Polyps Sun-jin Boo 1, Jeong-sik Byeon 2, Seon Ok Kim 3, Ji Hoon Jung 2, Jae Ho Park 2, Soo-young Na 1, Kee Wook Jung 2, Dong-hoon Yang 2, Kyung Jo Kim 2, Byong Duk Ye 2, Seung-jae Myung 2, Suk-kyun Yang 2 and Jin-ho Kim 2 1 Department of Internal Medicine, Jeju National University School of Medicine, Jeju, 2 Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 3 Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Background / aims: This study aimed to obtain the baseline data regarding technical competence for endoscopic mucosal resection (EMR) of colorectal polyps by experienced colonoscopists and to investigate the amount of training necessary for acquisition of technical competence for colon EMR in trainees. Methods: Baseline data were obtained from three experienced colonoscopists. Trainees were three gastroenterology fellows who had experienced more than 150 cases of diagnostic colonoscopy before this study. The success of individual colon EMR procedure by trainees was defined if (1) en bloc resection was obtained and (2) EMR time was within two times of median colon EMR time by experienced colonoscopists. Results: Experienced colonoscopists showed median colon EMR time of 79 sec. 750 colon EMR procedures in 410 patients were performed by three trainees. The average size of polyps was 7.8 ± 2.5 mm. The median colon EMR time, en bloc resection rate and complication rate were 118 sec, 95.6% and 6.8%, respectively. The colon EMR times by trainees shows a significant EMR time decrease as the experience accumulated (p<0.001). En bloc resection rate also improved (p=0.011). However, the rate of complication did not change significantly in trainees (p=0.140). The frequency of successful colon EMR had increased steadily and trainees reached the success rate of 81.3% in colon EMR procedures (p=0.003). Conclusions: In trainees, colon EMR time decreased and en bloc resection rate improved steadily till 250 cases. At least 250 colon EMR experience may be necessary for technical competence of colon EMR after the achievement of technical competence for diagnostic colonoscopy. Keywords: Colorectal polyp; EMR; Technical Competence POT-11 Endoscopic Ultrasonography Guided Drainage of Pelvic Abscess Caused by Cecal Perforation after Colonic Endoscopic Submucosal Dissection Shang Hoon Han, Jin Woong Cho, So Hee Yun, Jae Un Lee, Moon Sik Park, Wang Guk Oh, Young Jae Lee, Ji Woong Kim, Gum Mo Jung and Yong Keun Cho Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea Contents: Pelvic abscesses have usually been drained by surgery or radiologic percutaneous drainage. Lately, as the therapeutic role of endoscopic ultrasonography (EUS) is developing, EUS guided drainage of pelvic abscesses have been considered as an alternative method. Figure 1. 7*10 cm sized mature abscess in pelvis. 420 IDEN 2013 / 12 th KJSGE

33 Poster Presentation Abstracts (LWR) has been applied for resection of the subepithelial tumor (SET) less than proper muscle layer. Hybrid NOTES is a combined endoscopic and laparoscopic procedure to remove the SET. Methods: This is a retrospective analysis using prospectively collected data at a single tertiary referral center. From January 2008 to December 2012, 35 patients with intraluminal growing SET originated in proper muscle layer were included. Twenty-two were treated with the LWR and 13 were conducted by hybrid NOTES. Figure 2. perirectal abscess drainage using insertion of pig-tail stent. We report an interesting case of pelvic abscess with EUS-guided transrectal drainage. A 52-year-old female received surveillance colonoscopy and a 5 cm sized lateral spreading tumor (homogenous granular type) was detected in the cecum. The colonic endoscopic submucosal dissection (ESD) was performed with flex knife in our hospital. After the ESD, she developed colonic perforation and was managed conservatively. She was discharged without symptom in the 12th day. But, 9 days later she presented watery diarrhea. Sigmoidoscopy and abdomino-pelvic computed tomography showed a large pelvic abscess. EUS-guided drainage was performed with the insertion of pig-tail stent. In the 27th day, the abscess was improved completely and the stent was removed. So, we could managed pelvic abscess by EUS-guided drainage successfully and reported the case. Keywords: Endosonography; Abscess; Drainage; Colonic Perforation Results: In LWR group, there were 12 of gastrointestinal stromal tumor (GIST), 4 of leiomyoma, 3 of schwannoma, and 3 of ectopic pancreas. In hybrid NOTES group, there were 11 of GIST including 1 malignancy, 1 leiomyoma, and 1 schwannoma. Mean tumor sizes of LWR and hybrid NOTES groups were 25.2 mm and 19.8 mm, respectively (p = 0.124). Mean treatment duration of LWR and hybrid NOTES groups was 77 min and 84 min, respectively (p = 0.618). All tumors were completely resected without intraoperative or postoperative adverse events. In hybrid NOTES group, mean resection size was significantly small compared with laparoscopic wedge resection group (33.4 mm vs mm, p = 0.031). There was no significant difference in safety margin. Conclusions: Hybrid NOTES is a feasible minimally invasive procedure that can achieve smaller resection size, similar treatment duration, and en-bloc tumor resection compared with the laparoscopic wedge resection. Keywords: NOTES, Subepithelial tumor, Stomach, Wedge resection POT-12 The Comparison of Laparoscopic Wedge Resection and Hybrid Notes in Treatment of Intraluminal Growing Gastric Subepithelial Tumors Mi-young Kim 1, Joo Young Cho 1, Min Jeong Kim 1, Jun-hyung Cho 1, Yong Jin Kim 2 and So Young Jin 3 1 Digestive Disease Center, Soon Chun Hyang University Hospital, Seoul, 2 Department of Surgery, Soon Chun Hyang University Hospital, Seoul, 3 Department of Pathology, Soon Chun Hyang University Hospital, Seoul, Korea Background / aims: The laparoscopic wedge resection POT-13 Rare Case of Sarcomatoid Renal Cell Carcinoma with Concomitant Gastric and Colonic Metastases Ki Yung Boo, Yoo-kyung Cho, Seung Uk Jeong, Sun Jin Boo, Soo Young Na, Hyun Joo Song, Jung Mi Kwon, Eun Kwang Choi and Byung Cheol Song Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea Contents: BackgroundSarcomatoid renal cell carcinoma is a rare subtype of kidney malignancy and meta- IDEN 2013 / 12 th KJSGE 421

34 IDEN 2013 / 12th KJSGE stasis to gastrointestinal tract is uncommon. We report a case of sarcomatoid renal cell carcinoma with multiple metastases including stomach and colon. Case reporta 65-year-old man presented with right upper abdominal pain for 3 days. Laboratory findings on admission showed leukocytosis (11,900/ ), elevated serum creatinine (2.0 mg/dl), elevated hs-crp (5.77 mg/dl) and elevated procalcitonin (12 ng/ml). No hematuria was noted. Abdominal ultrasound revealed a 4cm sized right renal mass and a 2cm sized hepatic mass suggestive of renal and hepatic abscess. After antibiotic treatment for 5 days, serum creatinine was normalized and constrast-enhanced abdominal CT was performed. An enhanced ascending colon polyp, a 3.6cm sized pleural-based mass on left lower lung field and lumbar spinal osteolytic lesions were first recognized in addition to known renal and hepatic mass. Under the impression of metastatic malignancy, gastroduodenoscopy and colonoscopy were performed to find origin. Gastroduodenoscopy revealed multiple hemorrhagic polypoid lesions on the body and the fundus. Colonoscopy revealed a 1.2cm sized hemorrhagic cecal polyp. Pathologic findings from stomach and colon didn t show adenocarcinoma, but sarcomatoid carcinoma. Renal mass biopsy revealed sarcomatoid renal cell carcinoma and finally diagnosed as sarcomatoid renal cell carcinoma with gastric, colonic and hepatic metastases. He was planned to receive chemotherapy and transferred to other hospital as he wanted. ConclusionsMultiple hyperemic, hemorrhagic polypoid lesions of the stomach and the colon should Figure 1. Abdominal CT showed (A) renal mass (B) hepatic mass (C) right colon polyp and (D) pleural mass. 422 IDEN 2013 / 12th KJSGE Figure 2. Endoscopic examination showed multiple hyperemic hemorrhagic polyps on (A) lower body, (B) midbody, (C) fundus on the stomach and (D) cecum. be ruled out metastatic carcinoma and pathologic confirmation is very important for differential diagnosis. Keywords: Sarcomatoid renal cell carcinoma; Gastric metastasis; Colonic metastasis POT-14 Mesocolon Laceration Following Colonoscopy Jin-seok Park, Seok Jeong, Byoung Wook Bang, Don Haeng Lee, Hyung Gil Kim, Yong Woon Shin, Kye Sook Kwon, Jin-woo Lee and Young Soo Kim Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea Contents: Colonoscopy is a safe procedure, but sometimes unexpected complications can be occurred. Bleeding and perforation of the colon were reported as the most common complications. Hemoperitoneum after colonoscopy is an unusual complication of colonoscopy, but it may be catastrophic. We report a 20-years-old man who presented with left low quadrant pain following colonoscopy. Hemoperitoneum was diagnosed by abdominal CT. Laparoscopic exploration was urgently performed. Laparoscopic examination revealed laceration of the mesocolon of descending colon. The bleeding of the injured site could be controlled without complication. The patient recovered fully without signs of recurrent bleeding. This report implicates that if the patient has

35 Poster Presentation Abstracts POT-15 A Case of Idiopathic Sclerosing Encapsulating Peritonitis Figure 1. Contrast enhanced CT scans show hyper-attenuated fluid collections0 in the anterior aspect of sigmoid colon of pelvic cavity, both paracolic gutters and right subhepatic space, suggesting intraperitoneal hemorrhage. Figure 2. Laparoscopic finding. Moderate amount of blood is noticed in pelvic cavity. persistent abdominal pain after receiving colonoscopy, we should consider hemoperitoneum as one of the causes. To our knowledge, there was no reported case of isolated laceration of the mesocolon of descending colon developed after colonoscopy up to now Keywords: Mesocolon, Colonoscopy, Hemoperitoneum Hyun Sik Hwang 1, Joong Goo Kwon 1, Jin Tae Jung 1, Eun Young Kim 1, Jimin Han 1, Ho Gak Kim 1, Chang Ho Cho 2 and Hyun Dong Chae 3 1 Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, 2 Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, 3 Department of General Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea Contents: Sclerosing encapsulated peritonitis (SEP) is a rare form of peritoneal inflammation that results in an intestinal obstruction due to total or partial encapsulation of small bowel by peritoneal fibrosis and adhesion. It is reported to occur as an idiopathic form or secondary form in association with peritoneal dialysis, surgery, and recurrent peritonitis. We experienced one case of idiopathic SEP presented as small bowel obstruction. A 74 year-old man presented with an acute onset abdominal distension, palpable abdominal mass and vomiting. There was no medical history of peritoneal dialysis, infection, or abdominal surgeries. An abdominal examination revealed a firm immovable round mass in the upper abdomen, without tenderness and bowel sounds were decreased. Upper gastrointestinal endoscopy showed distended stomach and duodenum. Abdominal computed tomography (CT) showed small bowel loops congregated to the center of abdomen encased by a thick enhanced peritoneum. Double balloon enteroscopic examination showed no luminal obstruction up to mid-jejunum. He failed to respond to conservative treatment, thus an exploration laparotomy was performed. Surgery revealed an entire small bowel encased in a thick and whitish fibrotic tissue capsule, simulating a cocoon. After a dissection of the fibrotic capsule from the visceral surface, small bowel was completely released. Pathological findings showed intensive fibrosis, which was compatible with the diagnosis of sclerosing peritonitis. Abdominal distention recurred 10 days after operation and follow-up abdominal CT showed similar findings of preoperative state. His symptoms did not respond to conservative treatment. Keywords: Sclerosing encapsulated peritonitis; Intestinal obstruction; Peritoneal fibrosis IDEN 2013 / 12 th KJSGE 423

36 IDEN 2013 / 12 th KJSGE POT-16 A Case of Cronkhite-Canada Syndrome Improved by Long-term Intake of Rabeprazole. Kayoung Kim 1, Hiunsuk Chae 1, Hyungkeun Kim 1, Youngsuk Cho 1, Sunyoung Ko 1, Seunghye Jung 1 and Kyungjin Seo 2 1 Department of Internal Medicine, Uijeongbu St Mary s Hospital, Catholic University of Medical College, Uijeongbu, 2 Department of Pathology, Uijeongbu St Mary s Hospital, Catholic University of Medical College, Uijeongbu, Korea Contents: Cronkhite-Canada syndrome is a rare, unknown etiologic and non-familial syndrome presenting numerous hamartomatous polyps throughout the GI tract sparing the esophagus. The common symptoms of the disease are diarrhea, weight loss, nausea, vomiting, hypogeusia, anorexia. The unique ectodermal abnormalities are accompanied with alopecia, cutaneous hyperpigmentation, and dystrophic changes of nails. The diagnosis is based on history and physical examination, imaging and endoscopic findings with histopathology. Many complications, including GI bleeding, intussusception, prolapse and infection have been reported. Despite therapy, including treatment with steroids and antibiotics, the affected patients still display poor prognosis Figure 2. Follow-up endoscopic findings after rabeprazole treatment for 1 year: stomach(a), duodenum(b), and colon (C): few polypoid lesions were observed. with high mortality rate (60%) and substantial occurence of GI malignancy (10%). We herein report a case of Cronkhite-Canada syndrome improved by chronic use of rabeprazole.a 52-year-old man visited for lower abdominal pain, diarrhea and weight loss for a month. He had no familial and previous medical history. On physical examination, brittle and friable nail changes with alopecia were observed. Laboratory investigations showed no abnormalities. Esophagogastroduodenal endoscopy and colonoscopy showed immeasurable polyps of whole mucosa (more than 100 polyps) in stomach, duodenum and colon (Fig 1). Biopsies were obtained and their histopathology revealed hyperplastic polyps. Based on clinical features and biopsy findings, the diagnosis of Cronkhite-Canada syndrome was made. The patient was given 20mg of rabeprazole daily and all of clinical symptoms improved after 1 year. Follow-up of esophagogastroduodenal and colonoscopy were performed and they revealed near-complete disapperance of mulitple polyposis (Fig 2). Keywords: Cronkhite-Canada syndrome, Hyperplastic polyp, Rabeprazole POT-17 BRTO for Gastric Varices in an Infant,report of a Case Figure 1. Initial endoscopic findings of the patient s stomach (A), duodenum (B), and colon (C): observed immeasurable polyps; and histopathology (HE staining) of biopsy from the polyp in the stomach (D): the polyps contained an expanded, edematous lamina propria. Kazunori Hijikata, Yoshinori Igarashi, Ken Ito and Aya Sato Hepatorogy and Gastoroentrogy, Toho Univ,medicalcenter Oomori Hospital, Tokyo, Japan Contents: This case concerns a 14-year-old female patient with a low height and weight, but who otherwise had no history of attending hospital. While away from home she vomited blood and was brought into the 424 IDEN 2013 / 12 th KJSGE