7165LESS ASSOCIATION OF ADENOMYOMATOSIS WITH CANCEROF THE GALLBLADDER EVEN IF THE PRESENCE OFPANCREATICOBILIARY DUCTAL MALJUNCTION.Masaaki Yamazato, Jun Matsumoto, Akihiko Honda, HiroyukiShimosakoda, Yasunobu Akasaki, Takafumi Yamamoto, Takeshi Isechi,Jun-ichi Yoshikawa, Kazuaki Nakashio, Terukatsu Arima, KagoshimaUniv, Kagoshima, Japan.AIMS: Pancreaticobiliary ductal maljunction(PBM) is associated with sev-eral pancreatobiliary diseases including pancreatitis and carcinoma.Relation between adenomyomatosis (ADM) of the gallbladder and malig-nancy is not clear because of lacking of the data. However patients withADM but free from abdominal symptoms are usually followed as benignproliferative disease although it is hard to differentiate from gallbladdercancer. To clarify the relation, histological studies were conducted for spec-imens obtained by surgical resection of the gall bladder from patients withADM including those with both ADM and PBM. SUBJECTS AND METH-ODS: Four patients, 1 male and 3 females, with gallbladder ADM associat-ed with PBM and 32 patients, 21 males and 11 females, with gallbladderADM but free from PBM were enrolled in this study. In 13 patients with-out symptoms related to the pancreatobiliary area ADM was found bytransabdominal ultrasonography performed for the other purposes. ADMwere divided into 3 subtypes, segmental, fundal and diffused types. PBMand ADM were diagnosed by endoscopic retrograde cholangiopancreatog-raphy and histological study for the surgical specimen respectively.RESULTS: Among 32 patients with ADM free from PBM, totally 21(65.6%), consisting of 14 (66.7%) segmental type, 2 (66.7%) fundal type and5 (62.5%) diffused type had clinical symptoms. Of these 24 (75.0%)patients, consisting of 16 (76.2%) segmental type, 2 (66.7%) fundal type, 6(75.0%) diffused type were complicated by gallbladder stones. Howeverthere was no significant clinical difference among the subtypes. Two out of4 patients (50%) with ADM associating with PBM, belonging to segmentaltype, had symptoms. However none of the four patients were complicatedwith gallbladder stones. None of the thirty-six patients with ADM werecomplicated with gallbladder cancer at all. CONCLUSION: None of 36patients with ADM including 4 patients associated with PBM are not com-plicated with gallbladder cancer.

7166GALLBLADDER WALL THICKENING IN ACUTE HEPATITIS :WHAT IS THE CAUSE? Soon Koo Baik, Seong Jin Park, Hyun Soo Kim, Dong Ki Lee, Sang OkKwon, Wonju Coll of Medicine, Wonju, South Korea.Background/Aims: During ultrasonographic examination of patients withacute hepatitis, we can often see thickening of the Gallbladder(GB) walland contraction of the GB. However, there is rarely an opportunity for thehistological analysis of these structural changes. Endoscopic ultrasonogra-phy can delineate the GB wall structure accurately, thus it is helpful inobserving the changes of GB wall in patients with acute hepatitis. Hence,we attempted to disclose any detailed structural changes of GB wall inpatients with acute hepatitis using endoscopic ultrasonography. Methods:The subjects were 15 patients diagnosed as having acute hepatitis usinglaboratory and clinical data. We estimated the severity of the GB wallthickening and the change of each layer composing the wall of the GBusing endoscopic ultrasonography. Results: We observed a thickened GBwall in all the patients and the mean wall thickness was estimated to be5.6mm. In seven patients, hypertrophy of the muscular and serosal layerswas visualized with a mean thickness of 4.3mm, and each layer of the GBwall was well defined. A diffuely thickened GB wall without delineation ofeach layer was observed in 8 patients in which the mean wall thicknesswas 6.8mm. There was no significant relationship between the level ofserum AST/ALT and the degree of GB wall change. Conclusions: GB wallthickening in acute hepatitis results from the hypertrophic changes of themuscular and serosal layers, and the distinction between each layer of GBwall becomes difficult to delineate as the thickening progresses.

Comparison between patients with well defined GB walland those with ill-defined GB wall

Well-defined Ill-definedGB wall (n=7) GB wall (n=8) P-value

Wall thickness(mm) 4.3 ± 1.12 6.83 ± 1.58 0.03AST(U/L) 869.3 ± 1145.9 2094.5 ± 2471.3 0.283ALT(U/L) 1130.0 ± 1114.6 1841.0 ± 1313.1 0.252

7167EUS-GUIDED FNA COMPLICATIONS: A PROSPECTIVEANALYSIS.Mohammed Barawi, Klaus Gottlieb, Charlie Noyer, Mary Portis, James H.Grendell, Frank Gress, Winthrop-University Hosp, SUNY at Stony Brook,Long Island, NY.EUS-guided FNA complications: A prospective analysis. Background:EUS-guided FNA is now a widely accepted modality for diagnosing andsampling lesions in the gastrointestinal tract and surrounding structures.There is sparse data concerning complications associated with this rela-tively new endoscopic technique. Aim: This prospective study was under-taken to determine the frequency of complications associated with EUS-guided FNA including bleeding, perforation, bacteremia, infectiouscomplications and pancreatitis in the case of EUS-FNA of pancreaticlesions in our university hospital setting. Methods: All patients undergoingEUS-FNA between 1/98- 12/99 were enrolled in this study. Patients wereexcluded if they were on antibiotics or taking aspirin or NSAIDs. Duringthe procedure, the patient s vitals were monitored and the site of EUS-FNA was inspected carefully for signs of significant bleeding. Oral tem-perature was recorded before and at 30 and 60 minutes after the proce-dure. Blood cultures were collected in aseptic fashion 30 and 60 minutesafter the procedure. Radiologic studies and blood tests (CBC, amylase,lipase) were obtained when indicated. All patients were contacted 1 weekpost-procedure. Results: One hundred patients underwent EUS-FNA of107 lesions, mean number of passes was 3. There were 5 ampullary lesions,14 esophageal, 3 gastric, 1 adrenal, 2 liver masses, 18 mediastinal masses,61 pancreatic and 3 peripancreatic masses. There was no evidence of bleed-ing, perforation and pancreatitis. Blood cultures were negative except in 6patients having one of two bottles positive for coagulase negative staphy-lococcus considered to be contaminant. Seventy patients had their proce-dure as an outpatient; none were admitted or seen post-procedure in theER. All patients were doing well at call back one week post-procedure.Conclusion: EUS-guided FNA is an extremely safe procedure. Our datasuggests that EUS-guided FNA does not induce Bacteremia and is notassociated with infectious complications. Prophylactic antibiotics for endo-carditis prior to EUS-guided FNA (other than those delineated by ASGEand AHA) is not indicated.

7168DETECTION OF PANCREATIC METASTASES BY ENDOSONO-GRAPHY-GUIDED FINE NEEDLE ASPIRATION.Annette Fritscher-Ravens, Parupudi V. Sriram, Krause Christina, ZiyaAtay, Stafan Jaeckle, Frank Thonke, Boris Brand, Sabine Bohnacker, NibSoehendra, Dept of Interdisciplinary Endoscopy, Hamburg, Germany;Institute of Cytopathology Atay/Topalidis, Hannover, Germany; Univ HospEppendorf, Hamburg, Germany.Background: Metastases to pancreas cannot be differentiated from prima-ry pancreatic tumors based on imaging alone. Tissue diagnosis is impera-tive to plan appropriate treatment. Endosonography guided fine needleaspiration (EUS-FNA) is an alternative for cytodiagnosis of pancreaticlesions. Methods: Amongst 114 consecutive EUS-FNA from pancreaticlesions, metastases were diagnosed in 12 patients (9.5%). Longitudinalechoendoscopes and 22 gauge needles were used for EUS-FNA. Results:Mean age of patients was 61 years (36-74). Out of 6 patients with cancerin history (breast 3, renal cell 2, salivary gland 1) 4 had recurrence whiletwo had a second carcinoma metastasizing into pancreas. In those withoutprior cancer, cytology revealed metastases from renal cell, colonic, ovarianand esophageal primary tumors in 4 patients, respectively. One had malig-nant lymphoma, while the other primary site could not be identified. Theclinical outcome was poor (median survival 6 months). 8 patients receivednon-surgical palliation and 3 underwent surgery for their pancreaticmetastases. EUS showed metastases in the head/corpus of the pancreas,measuring 1.8-4 cm with inhomogeneous hypoechoic echotexture indistin-guishable from primary pancreatic cancer. Conclusion: Pancreatic metas-tases are one of the important causes of focal pancreatic lesions. EUS fea-tures are not characteristic for diagnosis. A simultaneous EUS-FNAenables cytodiagnosis and may avoid surgery.

AB284 GASTROINTESTINAL ENDOSCOPY VOLUME 51, NO. 4, PART 2, 2000