A130 VIDEOCAPSULE ENDOSCOPY VERSUS DOUBLE-BALLOON ENTEROSCOPY: WHICH ONE WINS?

Background

Videocapsule endoscopy (VCE) and double-balloon enteroscopy (DBE) are two endoscopic exams that permit the investigation of the small intestinal mucosa. There exists few studies that compare the diagnostic performance and results between these two diagnostic modalities.

Aims

To compare the diagnostic performance between VCE and DBE.

Methods

Retrospective study between 2016 and 2019. All patients at a tertiary care centre undergoing both VCE and DBE were recruited. Clinical and endoscopic information was compiled from patients’ medical charts as well as the indications and results of the two endoscopic exams. The patients with an incomplete endoscopy report or who were unable to complete both VCE and DBE were excluded. The results of both VCE and DBE were compared using univariate analysis.

Results

In total, 126 patients underwent VCE. Of those patients, 15 further underwent DBE (average age: 69±17, 53% female). In total, 11 patients underwent upper DBE, 3 patients underwent lower DBE, and one patient underwent both upper and lower DBE. The indications for endoscopy were: gastrointestinal bleeding (47%), iron deficient anemia (40%), and other (13%). The VCE findings were: angiodysplasia (35%), inflammation (35%), polyp/neoplasia (20%), and other (10%). The DBE findings were: angiodysplasia (41%), normal (35%), polyp/neoplasia (12%), stenosis (6%) and other (6%). In 53% of cases there was at least one finding concordant between VCE and DBE. In only 20% of cases, DBE found a new lesion that was not seen by VCE. In comparison, 33% of DBE exams were normal despite a positive findings by VCE. The discordance between exams was possibly due to the delay between both exams (average 125 days).

Conclusions

In over half of cases, there is at least one lesion consistent between both endoscopic modalities. DBE finds a new lesion that was not seen by VCE in only 20% of cases. Therefore, VCE should be the first choice in the investigation of the small intestine mucosa even though both exams seem to be complementary.

Funding Agencies

None

A129 VIDEOCAPSULE ENDOSCOPY RETENTION: WHAT ARE THE RISK FACTORS?

Background

The most feared complication of videocapsule endoscopy (VCE) is retention in the intestine. It is estimated to occur in 1.4% of cases but the risk factors are not well known.

Aims

To determine the prevalence of VCE retention at a tertiary care centre as well the associated risk factors.

Methods

Retrospective study between 2016 and 2019. All patients at a tertiary care centre undergoing VCE were recruited. The patients with an incomplete endoscopy report or who were unable to complete VCE were excluded. Clinical and endoscopic information was compiled from patients’ medical charts as well as the indications and results of the endoscopic procedure. VCE retention, evaluated by radiography or CT scan, was defined as persistence of the videocapsule in the gastrointestinal tract for ≥14 days or the need for an intervention for removal.

Results

In total, 126 patients underwent VCE (average age: 66±16, 52% female). There was 6% of patients with Crohn’s disease, and 40% of patients had a previous abdominal surgery. The indications for endoscopy were: iron deficient anemia (48%), gastrointestinal bleeding (32%), suspicion/follow up of IBD (10%), and other (11%). The VCE findings (n=146) were: angiodysplasia (30%), inflammation (30%), normal (20%), polyp (5%), and other (15%). 77% of results were not previously found by conventional endoscopy or imaging. The prevalence of VCE retention was 1.6%. The patient risk factors for retention were Crohn’s disease (OR 19.67; 95CI 1.09–354.11; p<0.05) and corticosteroid use in the previous 2 weeks (OR 19.67; 95CI 1.09–354.11; p<0.05). There was no risk of retention associated with ulcerative colitis, sex, abdominal surgery, or opioid use. The finding of stenosis on VCE was associated with an increased risk of retention (OR 123; 95% CI 4.11-3683.43; p<0.01).

Conclusions

VCE retention remains a rare complication. There is increased risk of retention in patients with known Crohn’s disease or recent use of corticosteroids.

Funding Agencies

None

Sex disparities in completeness of revascularisation and outcomes in patients with ST-elevation myocardial infarction and multivessel coronary artery disease

Background

In patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD), complete revascularisation is associated with reduced mortality compared to culprit only revascularisation. However, there are limited data regarding the relationship between sex and revascularisation strategy in STEMI with multivessel CAD and outcomes.

Purpose

Our aim is to evaluate sex related differences in treatment strategies and outcomes in patients with STEMI and multi-vessel CAD.

Methods

We included all consecutive patients from a provincial registry presenting with STEMI and multivessel CAD treated with percutaneous coronary intervention (PCI) from 2008–2015. The study population consisted of 856 females and 3152 males who were treated with culprit vessel only PCI or complete revascularisation using staged-PCI. The outcomes were death, admission for acute coronary syndrome (ACS), and admission for heart failure (HF). Multivariate Cox proportional hazard models were used to examine the association between treatment strategy and outcomes. Backward stepwise logistic regression was used to identify predictors of patients undergoing staged-PCI versus culprit vessel only PCI.

Results

At 3 years, the incidence of death was higher in females than males (15.9% vs. 8.2%, p<0.001), as were HF admissions (10.3% vs. 5.0%, p<0.001). Females underwent less staged-PCI than males (10.4% vs. 14.8%; adjusted odds ratio 0.75; 95% CI 0.57–0.97). Younger age and increasing Duke jeopardy score were also associated with performing staged-PCI.

After adjusting for baseline characteristics, females had a higher risk of death (HR 1.35; 95% CI 1.07–1.71), ACS admission (HR 1.27; 95% CI 1.00–1.60), and HF admission (HR 1.38; 95% CI 1.03–1.85). Following additional adjustment for revascularisation strategy, only death and HF admission remained significant. Females undergoing staged-PCI had similar survival to males (figure), with no significant interaction between revascularisation strategy and sex (p for interaction = 0.19)

Conclusion

Females with STEMI and multivessel CAD were less likely to be treated with complete revascularisation by staged-PCI and had worse outcomes when compared to males. Survival in both males and females treated with staged-PCI was similar. Our study suggests that addressing the lack of complete revascularisation in females presenting with STEMI may improve outcomes.

Figure 1

Funding Acknowledgement

Type of funding source: None

[The problem of breeding for spots in rabbits. 2. Further results on the variation of characteristics in fattening and breeding animals]

The mode of inheritance of spotting in both breeds (ES and DRS) is compatible with incompletely dominant resp. intermediate segregation, though a broad variability of spotted areas exists, indicating the influence of minor genes or other ontogenetic factors. Additional findings support the conclusion, that there is a very distinct predisposition of homozygous KK animals to develop megacolon with growing age. This also has consequences for the relative organ weight of the heart and of the adrenals in this genotype. Sporadically encountered accessory adrenal cortical tissue however did not exhibit genotypic preferences.

[The problems of spotted breeds of rabbits. 1. Fattening and body condition at slaughter, organ parameters]

Rabbits of the Giant German Spot Breed and of the English Spot Breed were bred, reared, fattened and evaluated under standardized conditions. A total of 50 animals (31 German spot = DRS; 19 English spot = ES; both derived from mating of heterozygotes) was tested, belonging to the three possible genotypes: Homozygous black (kk), heterozygous spotted (Kk, "standard animals") and homozygous spotted (KK, so-called "Chaplins"). As expected, breed differences consisted of better daily gains and higher carcass weights in DRS, but higher dressing percentages in ES. With respect to colour genotypes, only in DRS-KK depressions of daily gains and carcass weight were observed; food conversion efficiency however was even better in these animals (of both breeds), primarily because of lower feed uptake. Very distinct differences in some important organ traits could be demonstrated for those genotypes: A significantly augmented intestine (abs. and rel.) in KK-animals, specially with reference to the gross intestine--indicating a tendency to motility disturbances and/or chronic obstipation. This predisposition was underlined by the premature loss of three KK-rabbits suffering from severe corresponding symptoms. Seemingly analogous syndromes (Megacolon) in man and other species are cited, though further investigations are needed to clarify the etiology in spot rabbits. Significance of lower heart weights was stated in DRS-KK-animals, probably induced by minor activities observed in this genotype. Thus the K-gene can be classified as a subvital one when homozygous though manifestations of the symptoms obviously vary with the genetic background (breed, line) and perhaps with the environment.(ABSTRACT TRUNCATED AT 250 WORDS)