peutic approach, follow-up and survival were analysed. A comparativestatistic study concerning the localization, stage and histological charac-teristics of the primary CCR and the confirmed endoscopic recurrence wasalso conducted.Results: The gender distribution of patients with colic recurrence identifiedby endoscopy was 33 males (55%) and 27 females (45%) with a mean ageof 63,3 years. The mean time to recurrence was 23,8 months (4;72) and thefollow-up was less than one year in 51,7% of the cases. The carcinomas thathad ulterior recurrence occurred in the rectum in 56,7% of the cases. Thestage III was the most common (43,3%) and 83% had moderately andwell-differentiated adenocarcinomas. Almost 15% of the cases of CCRwith ulterior recurrence had complications: stenosis (8,3%), fistulating(3,3%) and adherent to at least one intra-abdominal viscus (3,3%).Therecurrent lesion was adenocarcinoma in 88% and tubulo-villous adenomain 12% of the cases. A surgical approach was made in 67% of the patients.About 38,3% of the cases had metastasis at the time of the diagnosis ofcolic recurrence. The mean survival was 3,25 years.

For the 1137 patients with surgical curative approach to CCR, therecurrence was higher in the descending and sigmoid colon (8,7% and8,2%)(p�0,05), stage III (13,7%)(p�0,05) and non and poor differentiatedcarcinomas (100% and 18,1%)(p�0,001).Conclusions: Although the endoscopic identified recurrence was morefrequent in the rectum, stage III and well/moderately differentiated adeno-carcinomas, the recurrence frequency (5,27%) was higher on the sigmoidand descending colon, stage III and non/poor differentiated carcinoma.

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THE ASSOCIATION OF STREPTOCOCCUS BOVISBACTEREMIA AND GASTROINTESTINAL DISEASE: ARETROSPECTIVE ANALYSISWaleed Alazmi, M.D., Tolga Erim, M.D., Colm J. O’Loughlin, M.B.,Jeffrey B. Raskin, M.D., FACG*. University of Miami/JacksonMemorial Hospital, Miami, FL.

Purpose: The relationship between Streptococcus Bovis Bacteremia (SBB)and colonic pathology, primarily colorectal cancer, has been well estab-lished. However, SBB is also frequently associated with chronic liverdisease, and has been described with carcinoma of the esophagus andstomach, gastric lymphoma, pancreatic adenocarcinoma and intestinal di-verticulosis. Colonic disease and alteration in immune regulation maypromote the overgrowth of S. Bovis and its translocation from the gutlumen into the portal venous system. Hepatic dysfunction may then con-tribute to bacteremia. The purpose of this study is to evaluate the preva-lence of gastrointestinal disease in patients with SBB.Methods: Retrospective analysis of the microbiology data base at JacksonMemorial Hospital, between 1992 and 2002, identified thirty eight patientswith SBB (19 males and 19 females, mean age of 56 yrs, range 19–80 yrs).Patients’ clinical records were reviewed, with special focus on underlyingliver, gastrointestinal disease and other major co-morbidities.Results: Nine patients (24%) had end stage liver disease (5 female). Sixpatients had alcohol-induced liver disease (one with concomitant chronichepatitis C) with the remaining 3 cases related to autoimmune hepatitis,primary biliary cirrhosis and non-alcoholic steatohepatitis. Colonic neo-plasms (adenocarcinoma in 3 and adenomatous polyps in 3) were found in6 of 10 patients (4 male, mean age 58 yrs) in whom colonoscopic evalu-ation was performed. Patients with hepatic dysfunction were younger thanthose with colonic neoplasms (mean age 49 yrs). Acquired immunodefi-ciency syndrome (AIDS) was identified in 7 cases (18%). Four were malewith a mean age of 52 yrs. Mortality in the patients with AIDS and SBBwas high (71%).Conclusions: This study confirms that bacteremia due to S. Bovis isfrequently associated with hepatic dysfunction (1:4), colonic neoplasms(1:6), and AIDS (1:5). SBB is an early clue to the likely presence of theseserious underlying conditions and warrants rigorous investigation whenrecognized.

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UNDERSTANDING OF COLORECTAL CANCER SCREENINGGUIDELINES AMONG INTERNAL MEDICINE RESIDENTSManjushree Gautam, M.D., Mansoor Ahmed, M.D., Sarba Kundu, M.D.,Sunitha Mannam, M.D., Mirza Ali, M.D., Sanjay Sangwan, M.D.,Juan Zubieta, M.D., Naushad Shaikh, M.D., Shailender Singh, M.D.*.Mercy Catholic Medical Center, Darby, PA.

Purpose: We conducted this survey to evaluate the knowledge and practiceregarding colorectal cancer screening among internal medicine residents.Methods: We administered a web based online structured questionnaireabout colorectal cancer screening to current internal medicine residents indifferent residency programs across the country. This questionnaire wasdeveloped from a previous survey and had been approved for contentvalidity.Results: A total of 216 internal medicine residents participated in thesurvey. Results were analyzed according to the level of training. Majorityof the respondents (89.1% PGY I, 88.9% PGY-II and 91.4% PGY-III)correctly identified age 50 years as the currently recommended age tocommence screening in an average-risk individual. 21.8% PGY-I, 31.5%PGY-II and 32.8% PGY-III residents indicated that the most appropriatemethod to begin CRCS is fecal occult blood test and flexible sigmoidos-copy. Only 23.6% PGY-I, 27.8% PGY-II and 29.3% PGY-III residentsindicated colonoscopy as the method of choice for colorectal cancer screen-ing. A significant number of first year residents indicated fecal occult bloodtesting alone as the method of choice for colorectal cancer screening.Interestingly, a greater number of residents (49.1% PGY-I, 66.7% PGY-IIand 84.5% PGY-III) chose colonoscopy as the preferred method of screen-ing for themselves as compared to the most appropriate method for thepatients. Most of them performed fecal occult blood testing in out patientsetting without prior dietary restrictions. Only 45.5% PGY-I, 51.9%PGY-II and 41.4% PGY-III residents gave appropriate dietary advice priorto performing FOBT. In two hypothetical clinical situations where expertsconsidered no screening appropriate, a large number of residents recom-mended some form of colorectal cancer screening.Conclusions: There is a wide variation in the understanding and practiceof colorectal cancer screening guidelines. Many offer screening to personsin whom it is not considered appropriate. FOBT is being performedinappropriately which may lead to higher false positive or negative results.It is not clear as to why more residents chose colonoscopy for personalscreening and suggested methods other than colonoscopy for screening thepatients. Further educational efforts should be directed towards residentsfor better understanding and implementation of the recommended guide-lines.

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LONG-TERM FOLLOW-UP OF THE DYNAMICGRACILOPLASTY RECONSTRUCTION FOR FAECALINCONTINENCEMichelle J. Thornton, F.R.A.C.S., Michael L. Kennedy, B.Sci.,Denis W. King, F.R.A.C.S., David Z. Lubowski, F.R.A.C.S.*. St GeorgeHospital, Sydney, NSW, Australia.

Purpose: This paper presents the long-term functional and quality of lifedata for patients who have undergone a dynamic graciloplasty reconstruc-tion for faecal incontinence.Methods: All patients (n�38) who had undergone a DGP at this institutionbetween 1991 and 2002 are presented. 33 were available for long-termfollow-up (median 60 months) and completed a telephone questionnaireassessing quality of life (QOL), bowel and sexual function and patientsatisfaction. All patients had interval anorectal physiology.Results: At a median follow-up of 5 years 16% of patients reported a faecalcontinence score �12. 30% of patients had been converted to an end-colostomy. 74% reported ongoing morbidity directly attributable to theoperation, including a 30% sexual dysfunction rate. Of those patients witha functional DGP 50% reported obstructed defecation and 64% reported

S108 Abstracts AJG – Vol. 98, No. 9, Suppl., 2003

that their bowel dysfunction negatively impacted on their QOL. Age,medical co-morbidity and anal manometry did not correlate with functionaloutcome. Quality of life scores and patient satisfaction scores positivelycorrelated with continence scores. There was a trend toward higher QOLand satisfaction scores with conversion to colostomy compared with acontinence score �12.Conclusions: The long-term continence rates following a DGP are lowwith a high peri-operative and long-term morbidity. Selection of thosepatients who may benefit from DGP in the long-term is yet to be defined.

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VALIDATION OF THE HIGH FREQUENCY WAVE FORMDEMONSTRATED IN THE HYPERTONIC INTERNAL ANALFISSURE: THE MICKLE WAVEMichelle J. Thornton, F.R.A.C.S., Michael L. Kennedy, B.Sci.,Denis W. King, F.R.A.C.S., David Z. Lubowski, F.R.A.C.S.*. St GeorgePublic Hospital, Sydney, NSW, Australia.

Purpose: Slow wave (sw) and ultra-slow wave (usw) activity is reported tobe increased in the physiology trace of the hypertonic internal anal sphinc-ter. A third wave form, first noted in anal fissure patients, is also present andthe aim of this paper is to validate the existence and consistency of thatwave form.Methods: The manometry traces of 60 anal fissure patients were recordedprospectively and analysed. The traces were then matched for age andgender with traces recorded from patients with either constipation or faecalincontinence on a pre-existing data-base. The remaining traces on thedata-base (n�1067) were then reviewed and all traces with a maximumanal resting pressure (mARP) greater than 89cmH20 (n� 389) were ana-lysed.Results: The Mickle wave (mw) only occurs at a mARP �110 cmH20. Thewave has a frequency of 1-1.5 cycles per second and has a maximumamplitude equivalent to 8.7% �2.91 (2SD) of the mARP. In 74% of tracesthe mw occurs in the presence of either sw or usw activity. In 26% of tracesthe mw occurs in isolation. These findings are irrespective of the presentingpathology.

The mw was identified in 23% of all fissure traces. The wave wasidentified in 4% of the matched traces, all of which had a mARP �140.From the remaining data-base mw were observed in 17% of the traces,0/134 traces with a mARP 110, 3/50 traces with a mARP 110-119, 4/50traces with a MARP 120–129, 11/38 traces with a mARP 130-139 and50/117 traces with a mARP �139.

Conclusions: The Mickle wave, identified only when the mARP is �110,usually in the presence of either sw or usw activity, has a consistentfrequency and predictable amplitude.

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RISK OF PROXIMAL COLORECTAL NEOPLASIA INPATIENTS WITH DISTAL HYPERPLASTIC POLYPSOtto S. Lin, M.D., Renee France, B.H.K., Drew B. Schembre, M.D.,Richard A. Kozarek, M.D.*. Virginia Mason Medical Center, Seattle,WA.

Purpose: Many clinical guidelines on colorectal screening do not considerdistal hyperplastic polyps to be a marker for proximal neoplastic disease inthe colon. However, out of 17 published studies on this topic, 10 haveshown an increased risk of proximal neoplastic lesions in patients withdistal hyperplastic polyps, while the 3 largest studies (Imperiale 2000,Lieberman 2000, Pinsky 2003) reported contradictory results. The purposeof this cross-sectional study is to assess the risk of proximal neoplasticlesions in patients with distal hyperplastic polyps, a clinically importantissue in order to determine whether or not patients with distal hyperplasticpolyps found on screening sigmoidoscopy require full colonoscopy.Methods: We assessed proximal (cecum, ascending, and transverse colon)and distal polypoid findings in consecutive patients undergoing screeningcolonoscopy, classifying them into one of three groups — those with distalhyperplastic polyps but no distal adenomas (Group A), those with distaltubular adenomas with or without distal hyperplastic polyps (B) and thosewithout distal polyps at all (C). The prevalence of proximal adenomas andproximal advanced neoplasia (large polyps �1cm, villous adenomas, dys-plastic lesions or cancer) was compared amongst the three groups using theChi-square test.Results: 2043 patients were included. Group A consisted of 198 patients,of whom 25 had proximal neoplasia (12.6%), including 4 with proximaladvanced neoplasia (2.0%); Group B comprised 197 patients, of whom 56had proximal neoplasia (28.4%), including 9 with proximal advancedneoplasia (4.6%); and Group C totaled 1638 patients, of whom 140 hadproximal neoplasia (8.5%), including 34 with proximal advanced neoplasia(2.1%). For the risk of proximal adenomas, p-value was 0.002 for Group Aversus B, 0.09 for Group A versus C, and �0.001 for Group B versus C.For the risk of proximal advanced neoplasia, p-value was 0.17 for GroupA versus B, 0.96 for Group A versus C, and 0.034 for Group B versus C.There were no differences in age or gender distribution between the threegroups.Conclusions: Patients with distal hyperplastic polyps, unlike distal adeno-mas, are not associated with an increased risk for proximal neoplasticlesions compared to those with no distal polyps. Hence, the discovery ofhyperplastic polyps on sigmoidoscopy should not necessarily prompt fullcolonoscopy.

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SUTURELESS, LAPARPSCOPIC RECTOPEXY: PRELIMINARYRESULTSRobert A. Aldoroty, M.D.*, Jeffrey S. Freed, M.D. Mount Sinai Schoolof Medicine, New York, NY.

Purpose: There are multiple methods used to repair rectal prolapse indi-cating that none is ideal. The classic sacral rectopexy suffers from asignificant incidence of fistulae formation and disruption. We postulatedthat the formation of fistulae is a result of the sutures being placed throughthe full thickness of the rectum. Therefore, we developed a suturelessmethod of rectopexy utilizing a fibrin sealant, Tisseel� (Baxter), andpolypropylene mesh. The method is very amenable to a laparoscopicapproach.Methods: The dissection is similar to the standard laparoscopic low ante-rior resection. It differs in that the lateral stalks of the rectum are preservedand there is no resection. The sacrum at and immediately below thepromontory is exposed in the midline. A 1 2 inch swatch of polypro-pylene mesh and the reduced rectum are fixed to the sacrum with fibrinsealant. We have performed this procedure on 5 patients, all women, witha mean age � 68 years.

S109AJG – September, Suppl., 2003 Abstracts