Sa1167 Determinants of Health-Related Quality of Life in Crohn's Disease: A Systematic Review...

cancer surgery is unclear. The aim of this study was to assess the feasibility and safety ofsurgery in obese patients with colorectal cancer. METHODS: A computerized medical litera-ture search was performed using Medline, Embase, Scopus, the Cochrane library, and theISI web of knowledge from 1980 to June 2012. Pooled odds ratios (OR) for dichotomousoutcomes and weighted mean differences (WMD) for continuous variables, with 95% confi-dence intervals (95%CI), were calculated using fixed or random effects models.We systemati-cally reviewed 20 observational studies, comparing obese and non-obese patients undergoingsurgery for colon, rectal or colorectal cancer. Heterogeneity and publication bias wereassessed. RESULTS: Twenty observational studies (totaling 9210 patients) were included.Mortality, overall complication rate, blood loss, anastomotic leakage, sepsis, length of hospitalstay, lymph node harvesting, and post-operative staging did not appear to differ significantlybetween both groups. Conversion rate to open surgery OR=2.19 (95%CI, 1.61-2.98) andwound infection rate OR = 1.84 (95% CI, 1.27-2.68) were found to be significantly increasedin obese subjects. Sensitivity and subgroups analyses showed that when both operative andpost-operative outcomes were considered, or when studies assessing rectal or colo-rectalcancer as a whole were excluded, overall complication rates were increased in the obesegroup (OR=1.38 (95% CI1.13-1.67); and 1.27 (95% CI1.08-1.51, respectively). Studiesincluding only Asian patients suggest a higher risk for wound infection and overall complica-tion. CONCLUSIONS: Obesity does not appear to influence negatively lymph node retrievaland cancer staging. Nevertheless wound infection and overall complication rate are increased,maybe more markedly in non-Asian studies.

Sa1166

Systematic Review and Meta-Analysis of Enhanced Recovery Programmes inEsophageal Cancer SurgeryAndrew J. Beamish, David S. Chan, Alex Karran, Paul A. Blake, Charlotte Thomas, WynG. Lewis

Aims. This systematic review and meta-analysis was performed to determine the influenceof enhanced recovery programmes (ERPs) on outcomes after esophageal cancer surgery.Methods. PubMed, Embase, the Cochrane library, and ClinicalTrials.gov were searchedfor studies on outcomes of esphagectomy in enhanced recovery programme or fast-trackprogrammes. The primary outcome measure was post-operative duration of hospital stay(LOHS), and secondary outcome measures were selected based on inclusion in two or morestudies. Statistical analysis was performed using odds ratio (OR) as the summary statistic.Results. Five studies totalling 854 patients with esophageal cancer were analysed. LOHSwas significantly shorter after ERP, when compared with controls (CON, standardised meandifference SMD -0.51, 95% confidence interval -0.66 to -0.35, p ,0.00001), but withsignificant heterogeneity between studies (I2=96%, p,0.00001). ERP was associated withless operative morbidity (p,0.0001), operative mortality (30-day mortality, p=0.020), andfewer anastomotic leaks (p=0.010). ERP was not associated with a higher incidence ofpulmonary complications (p=0.560) or more frequent readmission to hospital (p=0.800).Conclusion. Multimodal, standardised approaches to perioperative esophagectomy care wasfeasible, and cost effective.

Sa1167

Determinants of Health-Related Quality of Life in Crohn's Disease: ASystematic Review and Meta-AnalysisMike V. Have, Karen S. van der Aalst, Adrian A. Kaptein, Max Leenders, Peter D.Siersema, Bas Oldenburg, Herma Fidder

Background and aims: Health-related quality of life (HRQOL) is increasingly recognized asan important patient-reported outcome, although rarely implemented into clinical practice.A comprehensive understanding of the determinants of Crohn's Disease patients' HRQOLmay facilitate clinicians in clinical decision making, defining risk groups and allowing moreaccurate prediction of HRQOL. Therefore, we systematically assessed the determinants ofHRQOL in adult CD patients. Methods: The databases PubMed, EMBASE, the CochraneLibrary, PsycINFO and CINAHL were searched for English abstracts related to socio-demo-graphic, psychological, clinical and treatment-related determinants of HRQOL in CD. Twoindependent reviewers extracted study characteristics and assessed themethodological qualityaccording the criteria of Hayden et al. Main outcome was the number of studies showinga statistically significant association between the above-mentioned determinants and HRQOL.A meta-analysis was performed to quantify the relationship between disease activity andHRQOL. Results: Of the 2,060 articles identified, 24 original studies were included. Themajority of studies originated from Europe (15/24; 63%) and had a cross-sectional design(15/24; 63%). Sample sizes varied between 52 and 628 patients, with a majority of females(3576/ 5735; 62%) and with mean/median ages ranging from 29 to 45 years. Most studieshad a moderate to high quality. Data on psychological determinants were limited. Workdisability, increased disease activity, number of relapses, corticosteroid use and hospitalizationrate were significantly associated with a lower HRQOL in the majority of included studies.Use of biologicalspositively influenced HRQOL. The pooled data on the association betweendisease activity and HRQOL resulted in a weighed mean correlation coefficient of -0.61 (CI-0.65 to -0.57). Conclusions: HRQOL of adult CD patients is consistently determined bymarkers of active disease, including work disability, increased disease activity, number ofrelapses, corticosteroid use and hospitalization rate. However, these determinants are notvery helpful for clinicians when dealing with asymptomatic CD patients or when choosingbetween treatments with a comparable clinical efficacy. In addition, as disease activitycontributed to only 37% of CD patients' HRQOL, there remains a need for additional,possibly modifiable, determinants.

S-219 AGA Abstracts

Sa1168

Why Are We Not Treating Enough Hepatitis C?Jennifer Hsieh, Suvin Banker, Asim Khokhar

Background: Hepatitis C virus (HCV) has now become a major healthcare burden in theUnited States and is a leading cause of end-stage liver disease and transplantation. ThoughHCV therapy is widely available, numerous barriers to treatment including patient, providerand payer factors may influence the delivery of care. In the USA only 21% of infectedindividuals had received antiviral therapy by the end of 2007. Aims: To examine the barriersencountered by medical providers during treatment of HCV genotype 1 patients. Methods:We surveyed 66 gastroenterology providers at the 2012 annual American College of Gastroen-terology meeting in Las Vegas, Nevada. The questions included provider and patient demo-graphics, frequency of patient visits and patient characteristics that would bar treatment.Results: Most practices were in urban/suburban areas with minority being rural. 38% ofpractitioners had more than 15 yrs of experience vs. 42% with less than 5 years. 24% ofrespondents had hepatology training. 53% of providers had nurse practitioners that assistedthem. All practitioners had patient populations with mixed insurance payers. The majorityexperienced barriers in 25% of patients (past and present substance abuse, patient preferenceagainst treatment, psychiatric and medical co-morbidities, delays in obtaining clearance fromspecialists, and loss to follow-up). Most preferred to use triple therapy and more providerspreferred Teleprivir to Boceprivir, citing a simpler protocol and ease of use. 57% practitionerssaw patients once a month while on treatment, while 24% twice a month, 8% once a weekand 11% as needed. 86% of the providers felt financial compensation was inadequate forthe amount of work required. Discussion: Numerous barriers exist that prevent HCV patientsfrom being treated. In this study, we examined barriers faced by the medical providers.Most gastroenterologists were currently treating less than ten patients with hepatitis Cgenotype 1, about half had help in the form of nurse practitioners, and most felt the financialcompensation was inadequate for the time spent in taking care of patients. Much has beenstudied and published about the high costs of HCV treatment. Medications, blood work andhospitalization costs if needed, are significant. On the other hand, physician compensation isonly a small proportion. Providers spend a significant amount of time and energy duringthe treatment course along with responsibility and liability. Physicians are only compensatedup to two office visits a month under most insurances. Financially, this may be manageablein a large academic center setting but not in private practice. Providers will face difficultyin light of emerging therapies and complex treatment plans. Physician factors should beconsidered and solutions sought, otherwise much of Hepatitis C will remain untreated.

Sa1169

Incidence of Venous Thromboembolism in Gastrointestinal BleedingNeel Malhotra, Nilesh Chande

Background: Patients with acute gastrointestinal (GI) bleeding represent a challenging popu-lation to manage with respect to the safety of anticoagulant therapy for prophylaxis againstvenous thromboembolism during hospital admission. Methods: Over a two-year period,1014 patients with acute upper or lower GI bleeding were hospitalized at our centre.Inclusion criteria included those admitted with a primary diagnosis of a GI bleed along withany endoscopic confirmed source. Patients who developed GI bleeding while already admittedfor another reason were excluded. Only the initial event was considered in those withrecurrent hospitalizations. The primary end point was the development of venous thrombo-embolism (deep venous thrombosis or pulmonary embolism) within one year after presenta-tion. Results: Among those excluded, 359 patients developed GI bleeding after admissionand 121 had no definitive source of bleed identified. Data for 504 patients admitted withGI bleeding was eligible for review. Prior to admission, 324 patients were on some form ofanticoagulation (mostly aspirin, n=256). Upper gastrointestinal bleeding was more commonthan lower (n=350 vs. n=154). 397 patients (78.8%) were not given VTE prophylaxisduring their hospitalization. Of those that were, 36 patients (7.2%) were given prophylacticdalteparin or heparin for the duration of their stay. A further 38 patients (7.6%) were givenVTE prophylaxis for a portion of their hospitalization. 113 patients had at least one otherrisk factor for VTE including recent or subsequent surgery, past thrombotic events ormalignancy, however only 24 of these patients received VTE prophylaxis. The total numberof VTE events was 20 (3.97%). However, the incidence of thrombosis in those with other

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