S1525

Gastroesophageal Reflux (GER) Is Highly Prevalent

in Asymptomatic Patients Awaiting Lung TransplantationKalyani Maganti, Connie Wigen, Lorinda Dollison, Juan C. GarciaBackground: Bronchiolitis obliterans and its clinical correlate bronchiolitisobliterans syndrome are a major cause of morbidity and mortality following lungtransplantation. Aspiration secondary to GER has been postulated to bea contributing factor. GER has also been shown to worsen following lungtransplantation. Preoperative recognition would help anticipate management inthese patients. Methods: A retrospective study was performed to determine theprevalence of GER in 14 consecutive end-stage lung disease patients beingevaluated for lung transplantation. 12 had dual-channel esophageal 24-hour pHwhile 1 patient had BRAVO capsule testing. 13 patients underwent esophagealmanometry. Results: Among the 14 patients, indications for lung transplant were asfollowing: 6 emphysema, 3 idiopathic pulmonary fibrosis, 1 cystic fibrosis, 1pulmonary hypertension, and 1 alpha 1 antitrypsin deficiency. 12 patients wereasymptomatic for GER on presentation while 2 had heartburn. The loweresophageal sphincter was hypotensive in 9 (76%) patients with a mean loweresophageal sphincter pressure of 9.5 mm Hg. 4 (30%) had esophageal bodydysmotility. Among those 2 had low amplitudes with ineffective esophageal motility,likely secondary to GER as evidenced by abnormal pH study, and 2 had nutcrackeresophagus, one of whom had a positive DeMeester score. The overall DeMeesterscore was above normal in 9 (69%) patients with a mean score of 64.4 (normal!14.72). 7 (53%) were noted to have abnormal proximal acid exposure witha mean of 8.3% (normal !1.3% exposure). 9 (69%) had abnormal distal acidexposure with a mean of 18.4% (normal !4% exposure). Conclusions: GER ishighly prevalent in end-stage lung disease patients and can be clinically silent. Weconclude that all patients undergoing evaluation for lung transplantation,irrespective of symptoms, should be routinely investigated for GER in view of itspossible contribution to allograft dysfunction.

S1526

Endoluminal Gastroplication for the Treatment

of Gastroesophageal Reflux Disease: The First Multicenter Trial

in JapanSoji Ozawa, Masaki Kitajima, Koichiro Kumai, Kazuhide Higuchi,Tetsuo Arakawa, Mototsugu Kato, Masahiro Asaka, Natsuya Katada,Hiroyuki KuwanoBackground: Endoluminal gastroplication (ELGP) is a new endoscopic therapy forpatients with gastroesophageal reflux disease (GERD). Recent multicenter studiesin the US and Europe have been favorable, demonstrating that ELGP reducesheartburn and regurgitation. ELGP was first used in Japan in 2002. Aim: To evaluatethe effectiveness and adverse effects of ELGP in a multicenter Japanese trial.Methods: The inclusion criteria were a QUEST symptom score of 4 or more andendoscopic Los Angeles grade A, B, or C esophagitis. The exclusion criteria were anage of less than 18 years, pregnancy, dysphagia, endoscopic Los Angeles grade Desophagitis, obesity (BMI O 40), previous esophageal surgery or a hiatal herniagreater than 2 cm in length. We recruited 49 patients (32 men, 17 women; meanage: 57.3 years; range: 24 - 86 years). The mean QUEST symptom score was 9.3. Theaverage length of the hiatal hernia was 1.5 cm. We performed 58 ELGP proceduresin 49 patients using the EndoCinch system. All patients had circumferentialplications placed at 1 to 2 cm below the GE junction. Endoscopy, pHmeasurements, and symptom assessments were performed before and aftertreatment to monitor clinical outcome. The HB frequency score (HBFS) wasdefined as follows: 1 Z none, 2 Z ! 3 episodes per week, 3 Z 3 - 5 episodes perweek, 4 Z 6 - 7 episodes per week. The HB severity score (HBSS) was recorded bythe patients using a 5-point visual analog scale (1 - 5). Results: The mean number ofplacations was 2.5 (range, 1 - 4), and the average procedural time was 77.1 minutes(26 - 200 minutes). There were significant reductions in both HBFS and HBSS:HBFS decreased from an average of 3.5 at baseline to 1.5 and 1.6 at 3 and 6 monthsafter ELGP, respectively (P !.001), while HBSS decreased from an average of 3.3 to1.4 and 1.5 at 3 and 6 months after ELGP, respectively (P ! .001). The endoscopicgrade improved in 84% and 80% of the patients at 3 and 6 months after ELGP (P !.001). The % time spent with a pH of less than 4 decreased from 21.8% pre-ELGP to12.9% post-ELGP in 28 patients. Adverse events consisted of bleeding froma mucosal tear in 8 patients (14%) and pharyngitis in 1 patient (2%). No deathsoccurred. The rates of PPI - off or decrease were 69.8% and 66.6% at 3 and 6 monthsafter ELGP, respectively. The H2RA - off rates were 100% and 100% at 3 and 6months after ELGP, respectively. The survival rates of all complete placations were40%, 34%, and 19% at 6, 12, and 24 months after ELGP, respectively. Conclusion:ELGP is an effective and safe procedure for the treatment of GERD in Japan. Long-term follow-up to examine the durability of the plications is needed.

S1527

Mallory-Weiss Syndrome: Retrospective Review of Ten Years’

ExperienceSang-Hyuk Lee, Cheol Yoon, Doo-Geun Chai, Kyung-Im Bae,Seok-Woo Kang, Jae-Hwan Kim, in-Soo Jae, Sung-Jae Park, Sam-Ryon Ji,Yun-Jae Lee, Sang-Young Seol, Jung-Myung ChungBackground: Mallory-Weiss syndrome is known to cause 5-15% of uppergastrointestinal bleeding. The most common precipitating factor is known to vomitand retch related with a history of excessive drinking or physical findings consistentwith chronic alcohol abuse. The bleeding stops spontaneously in 90% of patients,and these patients can be managed conservatively. Endoscopic therapy is requiredwhen there are active bleeding or presence of stigma of recurrent bleeding. Thisstudy reviews the experience 156 patients over a 10-yr period, and was designed toasses the clinical characteristics, the endoscopic findings and the therapeuticresults of patients with endoscopically diagnosed Mallory-Weiss syndrome.Methods: Among 12521 cases of upper gastrointestinal bleeding from January 1995to April 2005, 156 cases(1.24%) were diagnosed as Mallory-Weiss syndrome byendoscopy. We reviewed patient’s medical records retrospectively. We assessedclinical characteristics, endoscopic findings and therapeutic results. Results: Themean age was 48.8 years and male:female ratio was 18.5:1. The frequentprecipitating factor was vomiting developed after drinking (65%). In these patients(110 cases), 42 cases (38%) occurred in winter, 21 cases (19%) in spring, 31 cases(28%) in summer and 16 cases (15%) in fall. Endoscopic findings revealed activebleeding in 33 cases (21%), blood clot without active bleeding in 87 cases (56%),and scar change in 36 cases (23%). In 113 cases (72%), coexisting diseases such asgastritis, gastric ulcer and esophageal varix were detected. The Mallory-Weiss tearswere located on gastric area in 25 cases (16%), on lower esophagus in 16 cases(10.4%), on gastroesophageal junction in 114 cases (73%), on gastroesophagus in 1case (0.6%). As for the number of tears, one tear was most common in 120 cases(77%), two tears in 27 cases (17%) and three or more tears in 9 cases (6%). On theview of direction of tear, 69 cases were on anterior wall side, 39 cases were onposterior wall side, 43 cases on lesser curvature side and 32 cases were on greatcurvature side. 115 cases (74%) were treated with supportive care, 23 cases withepinephrine injection, 16 cases with epinephrine with ethanol injection and 2 caseswith band ligation. Rebleeding was showed in 9 cases (6%). In cases of rebleeding, 5cases were on anterior wall side. Conclusion: Mallory-Weiss syndrome is closelyrelated with alcoholic intake. This study showed the incidence of Mallory-Weisssyndrome was lower than other study and more commonly developed at summerand winter. The bleeding stoped spontaneously in 74% of patients but endoscopictherapy was required in patient with risk factors.

S1528

The First Quadrant Sign: Predominance of Erosive Esophagitis

Occurring in the First Quadrant At the Distal EsophagusKhay Guan Yeoh, Reuben Km Wong, Kok Ann Gwee, Gabriel Lau,Khek Yu HoBackground: An original study to validate the use of the LA classification in Asianpatients incidentally showed a consistent pattern in the distribution of erosiveesophagitis at the distal esophagus. AimTo analyze the distribution of erosiveesophagitis at the distal esophagus and to propose a pathophysiologicalexplanation for the finding. Methods: In a recent study validating the use of the LAclassification for endoscopic esophagitis, video clips from consecutive patients withreflux esophagitis were randomly reviewed by 3 experienced endoscopists blindedto the diagnoses. The endoscopists were required to independently completea worksheet to score the presence, severity and distribution of esophagitis,including Barrett’s esophagus. The worksheet included a diagram showing theesophageal-gastric (EG) junction in cross-section as in a clock-face, and theendoscopists were required to mark the distribution of lesions. The 12 o’clock to 3o’clock quadrant was denoted the first quadrant (Q1) with the other quadrants (Q2to Q4) numbered in a clockwise direction. The prevalence of lesions by quadrantswas analyzed statistically using the ‘‘goodness-of-fit’’ test which assumes equalprobability of lesions in each quadrant that would be expected for a random effect.Further image analyses of barium swallow radiographs and computed tomographyscans in coronal views were undertaken to study the plane of the EG junction toexplain the findings. Results: 34 video clips with the following diagnoses by LAclassification: no esophagitis 5 (15%), grade A 21 (62%), grade B 7 (21%), grade C 1(3%), respectively, were scored and analyzed. The mean prevalence of erosiveesophagitis occurring in Q1 was 56.4% (range 50-63.6%), compared with 16.3% inQ2, 9.4% in Q3 and 17.8% in Q4 respectively. The goodness-of-fit test showeda highly significant difference with a p value !0.001. Imaging studies suggest thatthis is due to dependency of this quadrant at the EG junction. ConclusionIn thisseries of Asian patients with reflux esophagitis, our study showed a statisticallysignificant predominance of erosive changes occurring in the first quadrant,between the 12 and 3 o’clock positions. We postulate that the ‘‘First QuadrantSign’’ is an early endoscopic sign of mild erosive esophagitis, and that this is due todependency in this sector of the EG junction.

Abstracts

AB132 GASTROINTESTINAL ENDOSCOPY Volume 63, No. 5 : 2006 www.giejournal.org