A204 AGA ABSTRACTS GASTROENTEROLOGY Vol. 118, No.4

1268AN ACCURATE SIMPLE MEASURE OF PATffiNT RADIATIONEXPOSURE DURING ERCP BY PORTAL FILM DOSIMETRY.H. M. Kuan, J. A. Ferretti, J. W. Birk. S. F. Amanullah, K. I. Ashraf, B. J.Pollack, Univ Hosp and Med Ctr, SUNY, Stony Brook, NY.

Purpose: The radiation dose patients receive during diagnostic-therapeuticERCP procedures(ERCPs) is of importance yet often poorly quantified.Our protocol piloting the use of film dosimetry was developed for mea­suring/mapping skin doses during ERCPs. Dose distribution, calculatedrange and median dermal doses were recorded. Variations as to type ofprocedure, extent of disease, specifics in the use of equipment and patient­related factors were examined. Materials and Methods: Three 14" x17"portal films, progressively calibrated for a continuum of radiation dose(Kodak X-Omat V, calibrated for doses up to 50 cGy, EC film, calibratedto 150 cGy, and a new ISP Radiochromic film XXRF-I0404, calibrated to800 cGy and beyond) were stacked together and exposed during the entireprocedure by being placed between the x-ray table top and the patient whowas in prone position throughout. The undertable x-ray tube was of a fixed19" SSD, fluoro and spot films taken in auto mode with max kV of 110, and

1267ASSESSMENT OF GALLBLADDER MOTOR FUNCTION IN HU­MAN SUBJECTS: CHOLESCINTIGRAPHY COMPARED WITHDIRECT MEASUREMENTS OF INTRA-GALLBLADDER COM­PLIANCE.Adnan Ahmad, Salam F. Zakko, Cecile F. Guttermuth, Mozafareddin K.Karimeddini, Gale R. Ramsby, UConn Health Ctr, Farmington. CT.

Cholescintigraphy (HIDA) is classically used to quantify gallbladder (GB)motor function by calculating the percent change of GB volume in re­sponse to sincalide (CCK) as an indirect measure of GB ejection fraction.We previously described a direct method to assess GB compliance inpatients with percutaneous GB access. In this study we compare HIDAagainst this technique. To our knowledge, the accuracy of HIDA inquantifying GB contractility has not been validated against direct measure­ments in humans. METHODS: Five patients who were enrolled in apercutaneous gallstone dissolution protocol and who had functioning GBsby oral cholecystography were studied. Each patient had CCK stimulatedHIDA and direct GB compliance assessment in the fasting state within oneweek of each other. HIDA was performed by gamma camera imaging afteran IV infusion of 5 mCi of Tc-99m. A baseline image was obtainedfollowed by a slow IV infusion of sincalide 0.02 ug/kg over 30 minutes.GB imaging was repeated every 5 minutes. Direct GB compliance mea­surements were carried out utilizing the multilumen gallstone dissolutioncatheter that was already in place. All bile was evacuated from the GB thendilute contrast material was injected at a constant rate of 12 mUmin.Intra-GB pressure was measured through an independent catheter lumenand plotted in real time on an X-V chart recorder against the cumulativeinfused volume. The infusion was stopped when contrast was observedfluoroscopically to pass through the cystic duct. This pressure-volumecurve was repeated every 5 minutes after an IV infusion of CCK at thesame dose above. The % reduction in GB volume in response to CCK asdetected by HIDA is compared to the reduction in GB volume at the cysticduct pressure on the compliance curve. RESULTS: Both techniques de­tected a maximal steady state GB response 20 minutes after CCK. Valuesof GB ejection fraction obtained using these two methods correlated veryclosely, r=0.997(see Fig). CONCLUSION: GB response to CCK by HIDAstrongly correlates with direct intra-GB compliance measurements in pa­tients who have a patent cystic duct by oral cholecystography. Studies areunderway to determine if this correlation exists in patients with partial GBoutlet obstruction where HIDA may underestimate GB ejection fractionsince it only measures change in volume and not compliance.

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maximal coning employed to minimize skin dose. The films were subse­quently evaluated for dose distribution. Results: Calibration curves weredetermined for all three films. From 30 cases studied, the procedure fluorotimes 2.5 to 20 min (median 7), and the max anterior skin doses 10 to 110cGy (median 58) were well within the acceptable range for minimalradiation damage. Conclusion: The present work demonstrates a simple,rapid and accurate means of measuring patient dose, providing immediateidentification of cases exceeding set dose levels and allowing initiation ofpatient care measures. The protocol makes it simple to evaluate whethersteps taken for dose reduction during the procedure are effective. With thiscost-effective method, it is hoped that consistently monitoring all proce­dures would soon become a routine that helps reducing excessive exposureto radiation.

1269QUALITY OF LIFE OUTCOMES FOLLOWING ENDOSCOPICULTRASOUND FOR DYSPEPSIA / UNEXPLAINED UPPER AB­DOMINAL PAIN.1. Dill, B. Dill, Carilion Roanoke Community Hosp, Roanoke, VA.

Many patients with severe upper abdominal pain have negative conven­tional testing, including transabdominal ultrasound (TUS). Studies of En­doscopic Ultrasound (EUS) with and without Stimulated Biliary Drainage(SBD) demonstrated significant findings such as biliary sludge, microlithi­asis and otherwise occult pancreatitis. The present study aimed to deter­mine Quality of Life (QOL) outcomes post EUS/SBD with or withoutCholecystectomy. PATIENTSIMETHODS: A 2 yr. prospective Andy with64 pts. undergoing EUS/SBD for dyspepsia/unexplained upper abdominalpain after (-)TUS. Pts. with abnormal gallbladder (GB) EUS and/or mi­crolithiasis on SBD were considered for poss. Cholecystectomy. AbnormalGB EUS was defined as GB sludge or stones, or wall thickening (>3mm).At avo 21 mo. post EUS/SBD without surgery or avo 19 mo. post surgery,SF-36 questionnaires & pain relief questions were mailed to all 64 pts. (34return responses). U.S. Mean QOL summary scores on SF-36 are PCS 50,MCS 50. RESULTS: 34 pts. post EUS/SBD (female 29 (85%), male 5(15%) Post Cholecystectomy- 27 pts.; pain relief - 24 (89%)/QOL Scores:PCS 47.57 MCS 49.48, unimproved - 3 (II%)/QOL Scores: PCS 26.09MCS 38.15. No surgery -7 pts.; pain relief - 3 (43%)/QOL Scores: PCS47.14 MCS 49.56, unimproved - 4 (57%)lQOL Scores: PCS 27.40 MCS40.30. Positive Predictive Value: EUS/SBD for abnormal GB histopathol­ogy or GB microlithiasis = 100% CONCLUSION I. Av. 19mo. postCholecyglectomy, 89% of pts. with dyspepsia/unexplained upper abdom­inal pain after (+) EUS and/or SBD had pain relief. Av. SF-36 QOLsummary scores: PCS 47.57 MCS 49.48. -2. 4 pts. (57%) without surgerywere unimproved. Av. SF-36 QOL summary scores: PCS 27.40 MCS40.30. 3. EUS/SBD demonstrated 100% Positive Predictive Value forabnormal GB histopathology or GB microlithiasis.

1270ENDOSCOPIC TRANSPAPILLARY BIOPSIES AND INTRADUC­TAL ULTRASONOGRAPHY IN THE DIAGNOSTICS OF BILIARYDUCTAL STRICTURES.Dirk Domagk, Christopher Poremba, Karlheinz Dietl, Norbert Senninger,Wolfram Domschke, Josef Menzel, Univ of Muenster, Muenster, Ger­many.Introduction: The use of intraductal Ultrasonography (lDUS) performedduring endoscopic retrograde cholangio-pancreatography (ERCP) has be­come a valuable technique for the assessment of bile duct strictures.Methods: We examined 60 patients with biliary ductal strictures of un­known etiology by ERCP including transpapillary biopsies and intraductalultrasonography. All patients underwent laparotomy. Results: Final diag­nosis revealed 30 pancreatic carcinomas, 17 bile duct cancers, 3 gallblad­der cancers and 10 benign bile duct strictures. Using endoscopic transpap­illary forceps biopsies, a correct preoperative diagnosis was achieved in 27out of 60 patients (45% of the cases) resulting in a sensitivity of 55.7% anda specificity of 100%. IDUS showed higher values for bile duct cancer thantranspapillary biopsies with a sensitivity of 88.2% and a specificity of 86%.For neoplastic pancreatic lesions, IDUS had a sensitivity of 86.6% and aspecificity of 80%. ERCP supplemented with transpapillary forceps biopsyand IDUS allows a correct preoperative diagnosis in 78.3% of the cases (47out of 60 patients), which is significantly higher than transpapillary biop­sies alone (p<0.05). Conclusion: Because of low accuracy, endoscopictranspapillary biospy for itself is not a reliable diagnostic tool for definitepreoperative diagnosis of bile duct strictures. By adding IDUS and trans­papillary biopsy to ERCP, however, an improvement of preoperativediagnosic capacity is guaranteed. Accurate preoperative diagnosis of bileduct strictures is essential for planning therapy strategies.

1271VIRTUAL CHOLANGIOSCOPY USING TRANSABDOMINALTHREE-DIMENSIONAL ULTRASONOGRAPHY.Senju Hashimoto, Hidemi Goto, Yoshiki Hirooka, Akihiro Ito, YoshihiroIshiguro, Shinya Kojima, Takanori Hirai, Tetsuo Hayakawa, Yasuo Naitoh,Nagoya Univ Sch of medicine, Nagoya, Japan.

Three-dimensional (3D) images of bilialy diseases have made rapidprogress recently. Here we evaluated clinical usefulness of virtual cholan­gioscopy (VC) obtained with transabdominal three-dimensional ultra­sonography for bilialy tract diseases. Subjects and Methods Six persons