AI094 AGA ABSTRACTS GASTROENTEROLOGY Vol. 118, No.4

5063

SA FETY AND EFFICACY OF SURGICAL ENDOSCOPY INTRA­VENOUS SEDATION TECHNIQUES.Carlos Reyes, Jorge Hernande z, Rano Latipova, Luis Montero , Luis Gol­din, Cecilia Castillo, Fernando Fluxa, Roque Saenz, Claudio Navarrete,Marisa Valie nte, Cl in Santa Maria, Santiago, Chile .

The most efficie nt anaes thetic techniques in patients undergoing surgica lendoscopy have not been well defined till now. Aim: Co mpare and eval uatethe safety and efficacy of four different sedation techniques in surgicalendo scopy. Methods: 4 different seda tion techniqu es were analysed in a 2years prospective study. Group A: Midazolam (40 patients). Group B:PropofollMidazolam (200 patients). Group C: Propofol bolus (800 pa­tient s). Group D: Propofol TCI infusion (1000 patients). Patients wereclassified according to age, sex , ASA , and weight. They were monitoredfor arteria l pressure , pulse and oxygen saturation. All patients had 6litres/min of transnasal oxyge n. The ventilatory assis tance,adve rse effec ts,wak ing and discharge time were registered. Endoscopist comfort for in­tervention was evaluated in a I-tOO score. Results: (Table) Average agewas 68 years (10-102 years). The endoscopist comfort for interve ntion (I- 100 points) was A : 60, B: 85, C: 90 and D: 98 . Propofollm inuteconsumption was 15 mg for group B, 16 mg for group C and 11 mg forgroup D. Midazolam consumption was 10 mg (mean) in A group. Orotra­chea l intubation was required in: A =O patient s, B =2pat., C=lpat. andD= Ipat. Complications: Propofol TCI infusion is clearly the best anaes­thetic procedure for the endoscopist during surgical endoscopy, it is safeand efficient. It permits a higher number of cases done per session, veryshort post procedure stay, less haemodynamic alterations and less drugconsumption than the bolus techniq ue. Its handle and eventual complica­tions, that are rare, recommend monitoring and anaesthesis t assistance.

5065A COMPREHENSIVE ONE-STOP GI CLI NIC: SIGNIFICANT AD­VANCE ON DIRECT-ACCESS ENDOSCOPY.Deborah Ryan, Sinead Byrne, Kay Ennis, Padraic Macmathun a, MATE RHosp. Dublin , Ireland .

The current model of outpatient department (OPD) gastroentero logy (GI)service in Ireland is characterised by clinical assessment followed byendosco py, radiology and laboratory invest igations necessitating multipleattendances. In the current budget-conscious enviro nment, the challengeexists to provide quality care with finite resources . Although direc t-accessendoscopy is beco ming established, it lacks a comprehensive approach tocare. We report our experience of a fast track GI clinic that facil itates notonly immed iate clinical evaluation and endosco py, but also laboratory andon-site radiological assess ment. A retrospective audit was performed on100 randomly selected patients (fema les=65, males=35) from a total of244, over a two-year period (incorporating a patient satisfaction survey ,39% response) The median age was 40 years (range 17-79). The followingparameters were assessed: waiting time in clinic. type of investigations, noof visits, admissio ns, cross referrals and satisfaction rating. Of the 100patient s, 43% had no investigations while 42 of the remaining 56 patie nts(75%) had investigations performed in a single visit: 22% upper GIendosco py, 14% left-sided colonosco py, 3% full colonoscop y, 17% ultra­sound, 9% other radiol ogical procedures, 2 1% laboratory testin g with 6%having all of the investigations (endoscopy, lab, radiology). In total , 85%of patients attended for a single visit while only 14% returned for subse­quent visit(s). Cross referrals were (12%), dietician (6%) while (7%) wereadmitted. The overall patient satisfaction rate was 77% and diss atisfactionwas related to waiting time in the clinic before seeing a doctor, and lack ofphys ical space in the waitin g area . In conclusion, this model represents aparadigm, which significantly expands on the direct-access endoscopyconcept by providing a comprehensive and efficient Gl servic e.

A: Midazolam. B: PropololiMidazolam. C: Prepololbolus. D: Propolol infusion

Results: ComparativeDataBetween Defined Groups

5064DIAGNOSTIC AND TREATMENT CHARGES IN IRRITABLEBOWEL SYNDROME (18S) PATIENTS IN A MANAGED CARESETTING.Jean-Francois Ricci, Priti Jhingran, Lynn 1. Okamoto, Eric Carter, GlaxoWellcome, Raleigh-Durham, NC; NDC Health Information Service, Phoe­nix, AZ.

Diagnostic and treatment charges in Irritable Bowel Syndrome (IBS)Patients in a Managed Care Settin g PURPOSE: To measure the chargesassociated with the diagnosis and treatment of IBS and determine the mostcommon diag nostic and/or surgical procedures performed on IBS patientsin a managed care (MC) setting. Methods: A retrospective cohort analysi swas conducted using the PharMetrics Integrated Outcomes database thatincludes more than 20 managed care plans acro ss the US. Patient s with adiagnosis of Irritable Colon (lC D-9: 564 .1) betwee n Jan 1996 and Mar1998 were included. Patients had to be eligib le for at least 6 month s priorto and followi ng their initial diagnosis. Total medical charges as well as thefrequency of gastrointes tinal (GI) or genitourinary (GU) procedures wereinves tigated. Patients were assig ned to one of two groups based on theirtotal medica l charges-the upper 20 perce ntile of patients were compared tothe lower 80 percentile in term s of charges and GI or GU procedures.Results: 2770 patients (77% female, mean age 52 yr) were eligible for theanalysis . The one-year mean total charges /patient was $754 7 (SE = 271)or $629 per month . The largest contribu tor to total charges was inpatientcare, which acco unted for 4 1% of all charges, followed by medical man­agement (27%), ancillary serv ices (23%), and pharmacy charges (9%). Thetop 20 percentil e acco unted for 66% of all expe nditures . Common GIproced ures were eolonosco py (15% of all patients), endosco py (10%), andcholecystecto my (1.5%) . GU procedur es were perfo rmed on approx imately2% of all patient s. Patients in the top 20 percentile were more likely toundergo a colonoscopy (P<O.OOOI ), endoscopy (P<O .OOO I), or gallblad­der removal (P<O.OOOI). Exploratory endoscopy was more likely to beperformed prior to the index IBS diagnosis, while colonoscopy and cho­lecystectomy were more likely to be perfo rmed follow ing diagnosis. Con­clusion : IBS represents a substantial cost burden to Me. Even afterdiagnosis is documented, patients contin ue to undergo a lengthy and costlydiagnostic process before confirmation of IBS. There is a need for moreeffec tive IBS diagnostic and man agement approaches to decrease the cos tburden of IBS in MC settings .

Group Desaturation Ol A.Mild Moderate Severe

80·90% 70·80% <70%

Infliximab Controls

Patients 49 123Average age 43.1 42.1Gender (%male) 33% 33%Draining fistula 16% 14%Severity (perphysician assessment)

Remi1sion 10% 24%Mild 37% 49%Moderate 48% 25%Severe 5% 2%

Average IBOQ score 153 158

BaselineCharacteristics

5066TREAT REGISTRY: EXAMINATION OF THE LONG-TERM IM­PACT OF VARIOU S CROHN'S DISEASE TREATMENT REGI·MENS.William J. Sandborn, Gary L. Lichtenste in, Brian G. Feagan, Stephen B.Hanauer, Jeffrey S. Hyams, Bruce Salzberg, Thomas F. Schaible, MaryGlenn Vreeland, Leanne R. Larson, Lisa H. Mummert, Jeffrey P. Trotte r,Mayo Med Sch, Clin and Fdn, Rochester, MN; Univ of PennsylvaniaHealth System, Philadelphia, PA; Univ of Wes tern Ontari o, London, OK,Canada; Univ of Chicago Med Ctr, Chicago, IL; Connecticut Children 'sMed Ctr, Hartford , CT; Atlanta Gastroenterology, Atlanta, GA; Centoco r,Malvern, PA; Ovation Research Group , Highland Park, IL.

Purpose: To prospectiv ely assess the long-term impact of treatment regi­mens empl oyed in the management of Crohn ' s disease. Method s: TheTREAT Registry will examine clinical, eco nomic, and humanistic out­comes associated with Cro hn' s, This study bega n 8/1/99 and will includ eup to 500 physicians and 3,000-5,000 patients. Treatments and outcomeswill be assessed over 2-5 years . At baseline, patients receive/start inflix­imab or control therapies (com prising surgery, immunosuppressives, ste­roids, and anti-inflammatory agents) . At baseline and on a quarterly basis,physicians will record changes in therapy, disease severity, safety events,and hospitalizations. No predefined visits, therapies, or procedures arerequired. Every 8 weeks, patient s will complete the Inflammatory BowelDisease Questionnaire (IBDQ) and an economic questionnaire . Result s: Asof 11/30/99, 239 physicians had enrolled 355 patients. Baseline data wereavailable for 172 patient s; the attached table presents their profile. Con­clusions: Patient s treated with infliximab are significantly more likely tohave moderate to severe ly active Crohn's disease as assessed by theirphysicians. Contro l grou p patients have low IBDQ scores , suggesti ng that,from the patient perspective, they may be undertreated .

17(51032)15(610 21)14(7(020)10(5(019)

7.5171911

20875

101074

Total Hyper Hypo Wake timetenslon(%) tension(%) min(mean)

2.511

0.3

o2.51.250.6

7 5654.753.1

ABCD