12/13 procedures (one procedure performed for stent removal only). Successfulcannulation was achieved in 8/12 (67%) procedures (counting all proceduresincluding the 3 procedures where the papilla/hepatico-jejunostomy was notreached) and in 8/9 (89%) procedures (including only those procedures wherepapilla/hepatico-jejunostomy was reached). Endoscopic therapy was successfulin 9/13, 69% ERCPs (in 9/10, 90% after the papilla/hepatico-jejunostomy wasreached). Endoscopic therapy failed in only 1/10, 10% procedures after thepapilla/hepatico-jejunostomy was reached. Mean time for ERCP was 95.6 min(range 24-149 min). Endoscopic therapy included balloon dilation of biliarystricture in 3/13, 23%; stone extraction in 2/13, 15%; sphincterotomy in 3/13, 23%(2 biliary and 1 minor papilla sphincterotomy); stent placement in 3/13, 23%(Four 7-Fr bile duct stents in one procedure, one 7-Fr bile duct stent and one5-Fr dorsal pancreatic stent) and stent removal in 1/13 procedures (23%). Noadverse events were noted. Conclusions: Spiral-overtube assisted ERCP wassuccessful in majority of patients with surgically altered anatomy. Endoscopictherapy was successful in 90% after the papilla/duct-enterostomy was reached.

Su1381Greater Volume Resuscitation During the First 24 Hours AfterERCP Is Associated With a Less Severe Course of Post-ERCPPancreatitisSashidhar Sagi*, Suzette E. Schmidt, Evan L. Fogel, James L. Watkins,Lee Mchenry, Glen A. Lehman, Stuart Sherman, Gregory A. CoteGastroenterology, Indiana University, Indianapolis, INBackground: Intravenous volume resuscitation (IVR) represents the mostimportant early clinical intervention in pancreatitis to minimize the severity of itscourse. There are no data correlating volume resuscitation with the severity ofpost-ERCP pancreatitis (PEP), a unique etiology of pancreatitis in that manypatients present earlier in the disease course versus non-iatrogenic etiologies.The aim of this study was to compare early IVR in patients with mild versusmoderate to severe PEP. Methods: We conducted a retrospective cohort study ofpatients undergoing ERCP between January, 2009 and April, 2011 who weresubsequently admitted with PEP within 24 hours to our institution. PEP wasdefined as new or worsening abdominal pain with elevation in amylase or lipase� 3x upper limit of normal. Mild PEP was defined as hospitalization � 3 days,moderate (4-10 days) and severe (� 10 days). Patients were excluded if IVR dataduring the pre-, intra-procedure and post-procedure (up to 24 hours after ERCP)periods were unavailable. Patients with acute pancreatitis within 7 days of ERCP,chronic kidney disease and congestive heart failure were also excluded. Thereare no standard orders for IVR in patients admitted with PEP after ERCP, so theamount of fluid is left to the discretion of the treating physician. In addition toIVR data, medical records were abstracted for known risk factors for PEP and theuse of prophylactic PD stents. Variables are presented as medians withinterquartile ranges or simple proportions with 95% confidence intervals, withappropriate comparative statistics to determine significant differences. Results:We identified 70 eligible patients who underwent ERCP and developed PEPprompting admission on the same day as the procedure. Of these, 30 (42.9%)met criteria for at least moderate PEP with median hospital stay of 5 (4, 8) days;3 of 30 were severe. Sphincter of Oddi dysfunction was the indication for ERCPin 60% of mild and 40% of moderate/severe cases of PEP (p�0.10). Patients withmild PEP were similar to those with at least moderate PEP in terms of knowndemographic and endoscopic risk factors for PEP (table) except younger age.Patients with mild PEP received significantly greater IVR during the first 24 hours(2892mL) after ERCP compared to those with at least moderate PEP (2147mL,p�0.03). Median pre-procedure and intraprocedure IVR were similar in bothgroups (table, p�0.72). Conclusion: In patients with PEP, more aggressive IVRduring the first 24 hours after ERCP is associated with a less severe course. Thisis important preliminary evidence suggesting earlier and more aggressive fluidresuscitation may attenuate the course of PEP, and is consistent with otherstudies of volume resuscitation in acute pancreatitis. Prospective studiesevaluating the impact of IVR on the incidence and severity of PEP are needed.Characteristics between Mild and Moderate/Severe Post-ERCP pancreatitis

VariableMild PEP(n�40)

Moderate orsevere PEP

(n�30) p value

Demographic risk factors for PEPMedian age 36 (28,53) 50 (35, 56) 0.05% male sex 27.5 (13.7, 41.3) 13.3 (11.7, 25.5) 0.15

Endoscopic risk and protective factors for PEPPancreatic sphincterotomy (%) 55.0 (39.6, 70.4) 56.7 (38.9, 74.4) 0.89

Injection beyond pancreatic head(%)

78.6 (63.4, 93.8) 68.4 (47.5, 89.3) 0.44

Previous PEP (%) 16.7 (4.5, 28.8) 7.4 (0.0, 17.3) 0.27Previous pancreatic

sphincterotomy (%)32.4 (17.3, 47.5) 20.7 (5.9, 35.4) 0.29

Chronic pancreatitis (%) 27.5 (13.7, 41.3) 36.7 (19.4, 53.9) 0.41

VariableMild PEP(n�40)

Moderate orsevere PEP

(n�30) p value

Prophylactic PD stent placed (%) 80.0 (67.6, 92.4) 80.0 (65.7, 94.3) 1.0Early (within first 24 hours of ERCP) intravenous volume resuscitation

Total volume infused (mL) 2892 (1973, 3589) 2147 (1300, 2875) 0.03Volume infused before and

during ERCP (mL)600 (200, 800) 600 (400, 800) 0.72

Variables are expressed as medians (interquartile ranges) or percentiles (95%confidence intervals) PEP: post-ERCP pancreatitis

Su1382One-Year Experience With the Successful Use of a Novel PlasticDouble-Pigtail Biliary StentRobert a. Osterhoff*, Rosa M. Valadao, Karen C. Bagatelos,James W. OstroffGastroenterology, UCSF Medical Center, San Francisco, CABackground: Removable plastic double-pigtail stents are commonly used to treatbiliary obstruction. A new stent was recently developed by Cook Medical® toimprove upon their current design. The Compass® BDS stent is a polyethylene,dual tapered-tip design. The polyethylene material is softer and more malleablethan current Cook® stents with less memory at body temperature. The additionof two visual and radio-opaque markers identifies the pigtail locations via bothvideo endoscopy and fluoroscopy. Each pigtail is 5cm long and contains 17drainage holes, compared to 4-6 on conventional double pigtail stents. Theseinnovations are intended to increase the ease and accuracy of placement andallow for improved biliary and pancreatic drainage and stent durability. Methods:We began using the Compass® double-pigtail stent on October 1st 2010. Oneyear later we retrospectively reviewed all ERCP cases at our single academichospital during which a Compass® stent was placed. Results: A total of 346Compass stents were placed during 232 ERCPs from October 1st, 2010 throughNovember 8th, 2011. All stents were 7 french in diameter and either 5cm [N�79],10cm [N�225] or 15cm [N�42] in length. A single stent was placed in 117/232cases [50%]. Bilateral stents were placed in 111/232 [48%]. Three stents wereplaced in 4/232 [1.7%]. Indications for placement included malignant biliaryobstruction, cholangitis, anastomotic biliary strictures, primary sclerosingcholangitis, recurrent pyogenic cholangitis, trans-ampullary and trans-gastricdrainage of pancreatic pseudocysts as well as disruption and stricturing of thepancreatic duct. Our experience with stent placement was positive in that theradio-opaque markers and the malleable material improved the ease andaccuracy of placement. There were no complications or cases of stent migrationor malfunction and the stents were easily removed in all cases. Conclusion: TheCook® Compass® BDS double-pigtail stent is a promising new development dueto its ease and accuracy of placement. The addition of multiple pigtail holes hasthe potential to lead to longer patency times and improved drainage. The moremalleable material with less memory has potential implications for use in thepancreas without traumatizing the pancreatic duct, particularly in situationswhere a stent must be placed via the ampulla across a disruption in thepancreatic duct or into a pseudocyst. Future research will examine lengthenedintervals between ERCPs through improved patency and assess rates of stentocclusion, recurrent obstruction, and infection.

Su1383The Spectrum of Intraductal Endoscopy: a Review of SPYGLASSand Non-SPYGLASS Techniques in the Management ofPancreaticobiliary DiseaseGregory Lutzak*, Michael Gluck, S.Ian Gan, Shayan Irani,Andrew S. Ross, Richard A. KozarekDigestive Disease Institute, Virginia Mason, Seattle, WABackground: The performance of endoscopic retrograde pancreatography alongwith cholangioscopy (C) and pancreatoscopy (P) has evolved over the past 30years with advances in technology. Various prototype scopes have been utilizedfor direct visualization of the pancreaticobiliary tract. However, in recent yearsthe Boston Scientific single operator Spyglass (SG) system has become thepredominant visualization method. Objective: To review the C and P experienceat Virginia Mason with a focus on comparison of SG to other techniques fordirect visualization of the pancreaticobiliary tract. Design: Billing codes for all Cand P procedures completed in the last 8 years were searched to create a patientdatabase. A total of 205 patients (110 F, 95 M, mean age 63.3) were identified.Within this group 163 underwent C, 35 P, and 7 pancreatic cystoscopy. MainOutcome Measurements: Change in diagnosis or management based onperformance of endoscopic retrograde pancreatography in combination with P orC. Results: Nearly 70% of procedures (143/205) were completed using the SGsystem. The C group included 140 diagnostic procedures (104 SG), 20

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www.giejournal.org Volume 75, No. 4S : 2012 GASTROINTESTINAL ENDOSCOPY AB312

therapeutic cases (15 SG), and 3 cases performed via percutaneous transhepaticbiliary drainage tracts (3 SG). Diagnostic C altered management in 75% ofpatients using SG and 92% of patients using non-SG. Malignancy (n�48) was themost common diagnosis. Non-SG scopes included pediatric scopes (n�12) usedprimarily through choledochoduodenostomies, the Olympus mother daughtersystem and various prototypes.Therapeutic C achieved fragmentation of stones in80% of SG cases (12/15) and 75% of non-SG cases (3/4). Complete eradication ofstones occurred in 27% (4/15) of SG cases and 25% (1/4) of non-SG cases. Paltered management or diagnosis in 67% (16/24) of SG cases and 55% (6/11) ofnon-SG. IPMN (n�18) was the most common finding. Pancreatic cystoscopy didnot alter management (0/7). Conclusions: In this retrospective analysis, 205patients were reviewed with a mean age of 63.5 and a slight femalepredominance. Direct visualization of the bile ducts in both the SG and non-SGgroups affected management in at least 75% of the cases in which it was used. Inthe P group the effect was slightly smaller (�55%). Efficacy in complete stoneeradication was limited to about 25% of patients regardless of which scopesystem was used. In this single center, retrospective review the efficacy of the SGsystem appears to compare favorably with other endoscopic tools used tovisualize the pancreaticobiliary system.

Table 2. Pancreatoscopy Findings

Diagnosis Number of Patients

IPMN/Neoplasm 18

Diagnosis Number of Patients

Normal 7Pancreatitis 6Unclear 2Stricture 1Stones 1

Table 1. Cholangioscopy Findings

Diagnosis Number of Patients

Malignant Stricture 48Normal 25Inflammatory Stricture 18Stone 18Benign Stricture 7Mucinous Debris 7Ampullary Adenoma 5Choledochal Cyst 4Other 8

Su1384A Novel Basket Catheter “Reforma” to Facilitate EndoscopicRemoval of Pancreatic StonesNaoki Sasahira*, Hiroyuki Isayama, Naminatsu Takahara, Rie Nagano,Tsuyoshi Hamada, Suguru Mizuno, Koji Miyabayashi,Keisuke Yamamoto, Dai Mohri, Kazumichi Kawakubo,Hirofumi Kogure, Takashi Sasaki, Yukiko Ito, Natsuyo Yamamoto,Kenji Hirano, Minoru Tada, Kazuhiko KoikeGastroenterology, The University of Tokyo, Tokyo, JapanIntroduction: Endoscopic removal of pancreatic stones in the main pancreaticduct (MPD) in patients with chronic pancreatitis is still challenging because thereis no dedicated device for the narrow, irregular and tortuous duct. When using aconventional basket catheter for biliary stones, it is sometimes difficult toadvance the basket to the stones or to catch the stones or the fragments afterextracorporeal shockwave lithotripsy (ESWL). A novel basket catheter has beendeveloped to facilitate the removal of pancreatic stones. Methods: The novelbasket catheter “Reforma” is an 8Fr catheter which consists of double lumens;one for the basket and the other for a 0.025 inch guidewire. The basket iscomposed of nitinol wires with fine reticular structures in the distal end to catchthe small stones and of loose holes in the proximal part to release the stone afterthe extraction from MPD or when the basket is impacted at the stricture of MPD.The shape of the opened basket can be adjusted by the lever in the handle.Procedures were performed in 16 patients with chronic pancreatitis betweenDecember 2010 and September 2011. Eight of them were treated withconventional basket and balloon catheter at first, followed by Reforma(Conventional group), and the others were treated with Reforma at first,followed by the conventional way (Reforma group). Results: The novel basketcatheter was able to be advanced to the target stone in 15 of 16 patients (94%).In Conventional group, complete stone clearance was obtained only in 3 of 8patients (38%) with the conventional way alone and additional extraction byReforma was succeeded in 4 of 5 patients with residual stones. In Reformagroup, the complete stone clearance was obtained 6 of 8 patients (75%) withReforma alone. There was no mortality, and post-procedure pancreatitis wasseen in 3 of 16 patients (19%), all of whom are graded as mild pancreatitisaccording to the modified Cotton Criteria of prolongation of admission of lessthan 3 days. Conclusion: A novel basket catheter is useful for the extraction ofsmall pancreatic stones or fragments after ESWL.

Su1385A Blinded Comparison of Stent Associated Changes inPolyethylene and Sof-Flex® Material Pancreatic Duct Stents inPatients With Chronic PancreatitisAndrew L. Samuelson*1, Bernard E. Zeligman2, Paul D. Russ2,Raj J. Shah1

1Gastroenterology and Hepatology, University of Colorado Hospital,Aurora, CO;2Radiology, University of Colorado Hospital, Aurora, COBackground: Polyethylene stents (PES) have been used to treat pancreatic duct(PD) strictures to improve painful chronic pancreatitis. However, stent-associatedchanges (SAC) may develop in up to 80% of patients that include main ductnarrowing, irregularity, and side-branch ectasia (GIE 1996;44(3)268-75). We havealso used a multi-perforated PD stent wihout internal flanges consisting of asofter material since 2004. Whether the use of SFS has fewer SAC compared toPES has not previously been investigated. The aim of our study was to determine

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