after double balloon endoscopy (DBE). Repeated DBE may be necessary.However, few studies addressed the performance of repeated DBE. We aimed toevaluate the usefulness of repeated DBE in OGIB. Methods: We retrospectivelyidentified all OGIB patients who underwent DBE in the Cedars-Sinai MedicalCenter between 11/2004 and 10/2011. From this group of patients, we furtherabstracted data on repeated DBE for recurrent bleeding through the samedirection as in previous examinations. Results: Twenty nine OGIB patientsunderwent one repeated DBE through the same direction and 3 patientsunderwent two repeated DBEs. Therefore, a total of 35 repeated DBEs wereanalyzed. Fifteen of the 32 patients were males. The age of presentation for thefirst DBE was 72 years (range, 36-85 years). Before the first DBE, 7 had aprevious history of intestinal resection for the management of OGIB. Indicationof the first DBE was overt OGIB in 24 and occult OGIB in 8. Oral approach onlywas performed in 21, anal approach only in 3, and both approach in 8. The firstDBE identified a probable bleeding source in 21 (66%) of 32 patients: 16angiodysplasia (all with multiple lesions), 2 Dieulafoy lesions, 1 carcinoid, 1benign polyp, and 1 hyperemic patch of unknown etiology. Endoscopicinterventions, consisted mainly of argon plasma coagulation and clipping, wereperformed for all lesions except for the carcinoid that was treated by surgicalsmall bowel resection. Thirty two repeated DBEs were performed after a medianof 30 weeks (range 1-204 weeks). Indication of the repeated DBE was overtOGIB in 22 and occult OGIB in 10. Oral approach only was performed in 28and anal approach only in 4. Probable bleeding sources were detected in 17(53%) of 32 patients. Sixteen (94%) cases were angiodysplasia, of which 14patients had angiodysplasia also at the first DBE. All 17 patients with detectedbleeding sources were managed with endoscopic intervention that consistedmainly of argon plasma coagulation. Seventeen of 21 patients with positive firstDBE showed probable bleeding source at the repeated DBE while none of 11patients with negative first DBE finding did (81% vs. 0%, p�0.001). Other factorssuch as age, gender, indication, previous history of intestinal surgery, antiplateletagent, anticoagulation, and route of DBE insertion were not related to thedetection of bleeding sources at the repeated DBE. Three patients underwentsecond repeated DBE. Angiodysplasias were detected in 2 patients (67%).Conclusions: Repeated DBE through the same direction may detect bleedingsources in 53% of patients with recurrent OGIB, with virtually all cases related toangiodysplasia. The value of repeating a DBE in the same direction for patientswith a prior negative DBE for OGIB is questionable.

Sa1739Endoscopic Features of Sporadic Duodenal Polyps, Can WePredict Adenomas?Pablo Luna*, Gastón Babot Eraña, Lisandro Pereyra, Raquel González,José M. Mella, Guillermo Nicolás Panigadi, Carolina Fischer,Adriana Mohaidle, Adrián R. Hadad, Silvia C. Pedreira,Daniel G. Cimmino, Luis A. BoerrGastroenterology and Endoscopy Unit, Hospital Alemán, Buenos Aires,ArgentinaBackground: Sporadic duodenal polyps (SDP) are uncommon lesions and mostlydiscovered incidentally. Endoscopic identification of duodenal adenomas it’simportant due to their possible malignant transformation. Aim: To determine theprevalence and clinical characteristics of SDP in a community hospital inArgentina, and to identify independent predictors for adenomas. Methods:Endoscopic reports from patients undergoing upper gastrointestinal endoscopy(UGIE) from January 2003 to October 2011 were obtained from the electronicdatabase of a private community hospital of Argentina. All patients withduodenal polyps and histological examination were retrospectively included foranalysis. From the endoscopy report and clinical records the following data werecollected: demographic information, clinical manifestation, endoscopic featuresof the polyps, other endoscopic finding (gastric polyps, neoplasia andhelicobacter pylori status) and histology. Endoscopic approach, number ofendoscopy to diagnose and follow-up were also analyzed. Prevalence of SDPand adenomas was calculated. Univariate analysis was performed, to identifycharacteristics associated with adenomas. Results were expressed in percentagesand odds ratio (OR) with its corresponding 95% confidence intervals (CI). A pvalue � 0.05 was considered statically significant. Results: Of 7086 UGIEperformed in this period, 137 patients had a total of 150 polyps. The prevalenceof SDP was 2%. Patients were mostly males (56%), average age was 61.8 yearsold (27-90). Polyp’s morphology was: sessile (77%), flat lesions (17%) andpedunculated (6%). Average size and polyp number was 4.5mm and 1.76,respectively. 65% were localized in bulb. Most frequent endoscopic approachwas initial polypectomy (55%). The most common purpose of UGIE wasepigastric pain (35%), and heartburn (12%). Polyp final diagnose was: non-specific histological findings (34%), Brunner’s gland hyperplasia (31%),adenomas (17%), hyperplasic polyp (11%) and Gastric metaplasia (5%). Averagenumber of UGIE for diagnosis was 1.16. The prevalence of adenomas was0.33%; they were more frequently in second portion of duodenum with a meansize of 7mm (2-30mm). Only 36% had endoscopic surveillance and recurrencelesions were not found. Polyps size � 1cm (p�0.001 OR 5,68 CI 1,60 - 20,18),second portion location (p�0.000 OR 6,88 IC 2,43 - 20,13) and flat polypmorphology (p�0.000 OR 7,95 IC 2,71 - 23,63) were significantly associated with

adenoma. Conclusion: In the present study, the prevalence of SDP andadenomas was low, similar to that reported in the literature. We found asignificant association between endoscopic features and adenomas that couldoptimize the initial endoscopic approach.

Sa1740Clinical Usefulness of Combination Capsule Endoscopy and CTEnterography in Patients With Obscure GastrointestinalBleedingSeong Ran Jeon*, Jin-Oh Kim, Ji Ho Ahn, Hyun Gun Kim, Tae Hee Lee,Won Young Cho, Wan Jung Kim, Bong Min Ko, Joo Young Cho,Joon Seong Lee, Moon Sung LeeDepartments of Internal Medicine, Institute for Digestive Research,Digestive Disease Center, Soonchunhyang University College ofMedicine, Seoul, Republic of KoreaAims: Obscure gastrointestinal bleeding (OGIB) with negative gastroscopy andcolonoscopy findings is located mainly in the small intestine. The aim of study isto demonstrate the clinical efficacy of capsule endoscopy (CE) and computedtomography enterography (CTE) to diagnose as OGIB. Methods: From January2008 to September 2011 in Soonchunhyang University Hospital, 54 patients withfirstly diagnosed as OGIB were examined with CE in combination with CTE. Thedata were analyzed retrospectively and the positive findings were signs of activeor recent bleeding, observable sources of hemorrhage visualizing any attributablelesions. Results: Overall 54 patients (median age 57, men 66.7% and women33.3%) were enrolled. Thirty of 54 patients (55.6%) exhibited positive CE findingscompared with 12 patients (22.2%) on CTE alone (p � 0.01). When used incombination, 64.8% (35/54) of patients scored positive findings. The detectionrate with combination of diagnostic imaging was significantly higher than that ofCTE alone (p � 0.01), but was not significant higher than that of CE alone (p �0.06). The positive detection rate for CE was superior to CTE particularly fordetecting lesions limited to mucosa (15 vascular lesions: 87% vs 13%; 17superficial mucosal lesions: 88% vs 47%). Conclusion: The combination of CEand CTE is critical in the diagnosis of OGIB, given the fact that there was asignificant difference in the detection rate between CE plus CTE and CTE alone.Although there was no significant difference between CE plus CTE and CE alone,combination with CE and CTE increased the positive identification of OGIB, thusexpected to improve the clinical diagnosis and therapy.

Sa1741Angioectasia in the Elderly is the Commonest Cause of ObscureGastrointestinal Bleeding on Capsule EndoscopySamuel P. Costello*, Jonathan MartinGastroenterology, Repatriation General Hospital, Adelaide, SA,AustraliaBackground and Aims: Angioectasia of the small intestine are a common causeof obscure gastrointestinal tract bleeding. We have shown that targeted therapywith balloon enteroscopy and argon plasma coagulation is able to reducebleeding and transfusion requirements. We aimed to determine the yield anddistribution of angioectasia as well as the rates of active bleeding in different agegroups using capsule endoscopy in patients with recurrent iron deficiencyanemia. Method: We retrospectively analyzed data from 303 consecutive capsuleendoscopy studies performed from June 2003 until February 2010 for recurrentiron deficiency anemia. The presence of angioectasia, location (first or secondhalf of the small intestine) and presence of fresh bleeding were recorded alongwith demographic details. Results: There were 127 (42%) out of 303 patients withangioectasia and 43 (14%) with fresh bleeding associated with angioectasia seenat capsule endoscopy. 34 of 43(79%) had bleeding in the first half, 21 (48.8%)had bleeding in the second half and 12 (27.9%) had bleeding in both halves ofthe small bowel. The yield of angioectasia for patients � 80 years was 61% vs.21% for those less than 60 years (p�0.01). Those �80 years were not morelikely to have active bleeding. When present, angioectasia was more common inthe first half than the second half of the small bowel (72% vs. 54%; p�0.01).There was a trend toward more active bleeding in the patients with angioectasiain the first half of the small intestine (34% vs. 20%; p� 0.15). Conclusion: In thesetting of recurrent iron deficiency anemia, the yield for angioectasia at capsuleendoscopy is much higher in the elderly (�80 years). The most commonlocation for angioectastia and bleeding angioectasia is the proximal smallintestine.

Sa1742Capsule Endoscopy in Octogenarians: Analysis of a LargeProspectively Collected DatabaseVictoria Gomez*, Mihir K. Patel, Mark E. Stark, Frank LukensGastroenterology and Hepatology, Mayo Clinic, Jacksonville, FLIntroduction: Capsule endoscopy (CE) is a well accepted and accurate diagnostic

Abstracts

AB260 GASTROINTESTINAL ENDOSCOPY Volume 75, No. 4S : 2012 www.giejournal.org