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Introduction Chemo-responsiveness in pancreatic cancer is known to be dependent on fibrosis and vascularity. The purpose of this study was to assess vascular enhancement in advanced pancreatic adenocarcinoma with or without liver metastasis in computed tomography (CT) and to analyze the correlation between enhancement patterns and chemo-responsiveness. Methods Patients were assigned to either a responder group (partial response or stable disease) or a non-responder group (progressive disease) according to chemo-responsiveness assessed by CT before and after gemcitabine-based chemotherapy. Hounsefield unit (HU) was measured in pancreatic mass and the largest metastatic liver mass using region of interest (ROI). HU differences (ΔHU) between arterial and pre-contrast phase were calculated. Results Of the 101 study subjects, 78(77.2%) were assigned to the pancreas responder group {mean ΔHU (±SD), 36.7(±21.6)} and 23(22.8%) to the pancreas non-responder group {mean ΔHU (±SD), 20.6(±9.9)} (p = 0.001 for ΔHUs). Of the 46 study subjects with liver metastasis, 25(54.3%) were assigned to the liver metastasis responder group {mean ΔHU (±SD), 36.9(±21.0} and 21(45.7%) to the liver metastasis non-responder group {mean ΔHU (±SD), 17.1 (±24.0)}, (p = 0.005 for ΔHUs). Conclusion CT determined mass vascular enhancement patterns may predict chemoresponse in advanced pancreatic cancer.

sedation assistants for deep sedation during ERCP without increasing the risk of adverse events of deep sedation. Su1590 Role of the Direct PerOral Cholangioscopy Using an Ultra-Slim Endoscope After Endoscopic Extraction of Choledocholithiasis for Detecting Small Bile Duct Lesions Obscure in Conventional Imagings Hyun Jong Choi*, Jong Ho Moon, Yun Nah Lee, Hee Kyung Kim, Hyeon Jeong Goong, Moon Han Choi, Tae Hoon Lee, Sang-Woo Cha, Young Deok Cho, Sang-Heum Park Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea (the Republic of); Department of Pathology, SoonChunHyang University School of Medicine, Bucheon, Korea (the Republic of) Background: Direct peroral cholangioscopy (POC) using an ultra-slim upper endoscope can provide high-resolutional endoscopic images of the bile duct. Therefore, direct POC may detect obscure bile duct lesions in preceding imaging modalities including computed tomography, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography. The aim of this study was to evaluate the usefullness of direct POC using an ultra-slim upper endoscope after endoscopic extraction of choledocholithiais. Methods: Total 207 patients have undergone direct POC to evaluate bile duct clearance after endoscopic extraction of choledocholithiasis. All included patients had dilated extrahepatic bile duct more than 10 mm and were undergone endoscopic sphincteroplasty before POC. Patients with defined bile duct lesions in preceding imaging modalities were excluded in this study. Direct POC was performed by using an ultra-slim (! 5.5 mm in outer diameter of distal end) upper endoscopes. Abnormal POC findings were evaluated by using narrow band imaging and forceps biopsy under endoscopic guidance, if possible. Results: Direct POC was successful in 199 patients (96.1%). Abnormal intraductal lesions were detected in 31 patients (15.6%) including 3 villous mucosal lesions, 2 papillary mucosal lesions, 14 polypoid mucosal lesions and 11 nonspecific inflammatory lesions. POC-guided forceps biopsy was successful in 28/31 patients (90.3%) with tissue adequacy for the histologic evaluation in 24/31 (77.4%). Final diagnosis by histopathologic evaluation of abnormal bile duct lesions were 4 cholangiocarcinomas, 2 intraductal papillary neoplasms in the bile duct with dysplasia, 1 bile duct adenoma with dysplasia, and 24 nonspecific inflammatory lesions. Residual stones were detected in 25 patients (14.5%) and extracted under direct POC (92%, 23/25). Cholangitis conservatively managed was occurred in one patient (0.5%, 1/ 207) after direct POC. No other significant direct POC-related adverse events were occurred. Conclusion: Endoscopic evaluation with direct POC using an ultra-slim upper endoscope after endoscopic extraction of choledocholithiasis can be helpful to detect small bile duct lesions including cholangiocarcinoma that were obscure or overlooking in preceding imaging modalities. Su1591 Magnetic Resonance Cholangio-Pancreatography (MRCP) Has Low Sensitivity in Diagnosing Biliary Strictures After Liver Transplantation: a Single Tertiary Care Center Experience Ali Akbar*, Satheesh P. Nair, Mohammad K. Ismail, Muhammad Bilal, Jason Vanatta, James D. Eason, Salil Parikh, Sanjaya K. Satapathy Gastroenterology and Hepatology, University of Tennesse, Germantown, TN; Transplant surgery, University of Tennessee, Memphis, TN; Radiology, Methodist University Hospital, Memphis, TN Aim: Biliary strictures are common complication after liver transplantation (LT). We aimed to determine the accuracy of MRCP in diagnosing biliary strictures (BS) in liver transplant recipients (LTRs) when compared to direct cholangiographic methods (Endoscopic retrograde cholangio pancreatography (ERCP) and/or percutaneous transhepatic cholangiography (PTC). Setting: Tertiary care medical center performing O100 LT a year. Methods: Retrospective chart review of LTRs from 7/2008 until 4/2014 was performed. Those who had MRCP performed for suspected BS followed by ERCP or PTC within 4 weeks were included. BS on ERCP/ PTC without prior MRCP and those who underwent surgery or followed clinically after an MRCP were excluded. A cholangiographic narrowing (on ERCP/PTC) that required balloon dilation and/or stent placement was considered a biliary stricture and was considered clinically significant if the intervention resulted in atleast 30% improvement of bilirubin (bili) and/or alkaline phosphatase (AP) within 2 weeks. Data collected include LT indication, biliary anastomosis type, Pre-MRCP bili and AP, anastomotic vs non anastomotic BS, Immunosuppression at the time of MRCP, time intervals between LT & MRCP as well as between MRCP & ERCP/PTC. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of MRCP in diagnosing biliary strictures (with known ERCP/PTC findings) were calculated. Results: After review of 679 LTRs a total of 32 patients (18 males 54.5%, median age 52.6 8.8 years) were included. All had an MRCP followed by either ERCP or PTC within 4 weeks. HCV related end stage liver disease was the most common indication for LT (19/32 59.4%). Median LT to MRCP time was 387 (35-2285) days. Biliary anastoAB342 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5S : 2015 mosis was duct to duct in all except one who had hepatico-jejunostomy. Pre-MRCP bili (8.7 8.3mg/dl) and AP (657 525 unit/L) were elevated. 27 patients (84.3%) were on tacrolimus, 13 (39.4%) on mycophenolate, 7 (21.2%) on rapamycin, 2 (6.1%) on everolimus and 1 (3%) on cyclosporine at the time of MRCP. MRCP showed anastomotic BS in 14 of 32 patients. ERCP and PTC subsequently revealed a total of 21 BS (ERCP 15, PTC 6; 20 anastomotic and 1 non-anastomotic). This included all 14 seen on MRCP (PPV of 100%). Remaining 7 BS (6-anastomotic and 1 non-anastomotic), diagnosed on ERCP (5) and PTC (2), were not detected on earlier MRCP (Sensitivity 66.7%-cholangiographic BS). However only 4 of those 7 were clinically significant (Sensitivity 77.8%). 11 LTRs had no BS on either modality (Specificity of MRCP 100%). NPV of MRCP was noted to be 61.1% for cholangiographic BS (77.8% for clinically significant BS). Conclusion: Despite excellent specificity, MRCP may not show all biliary strictures in liver transplant recipients and hence, we recommend further direct cholangiographic evaluation in appropriate clinical settings. Baseline characteristics and Results Total Patients 32 Sex (male/female) 18/14 Age (years, median SD) 52.6 8.8 Reason for transplantation (n, %) HCV Cirrhosis 19 (59.3%) HBV Cirrhosis 1 (3.1%) Alcoholic Cirrhosis 3 (9.3%) Non alcoholic steatohepatitis Cirrhosis 3 (9.3%) PBC 1 (3.1%) Sarcoidosis 1 (3.1%) Othersy 4 (12.5%) Immunosuppression at MRCP (n, %) Tacrolimus 27 (84.3%) Mycophenolic acid 13 (40.6%) Everolimus / Cyclosporine 2 (6.2%) / 1 (3.1%) Rapamune 7 (21.8%) Type of Biliary anastomosis duct-duct / bilio-digestive 31 / 1 Time from transplantation to MRCP, days (median SD) 387 35-2285 Time from MRCP to ERCP/PTC ! 4 weeks in all 32

Feasibility of Surgicel® FibrillarTM in Patient With Colonic Postpolypectomy Bleeding: a Pilot Study Bong MIN Ko*, Moon Han Choi, Hyun Gun Kim, Seong Ran Jeon, Su Jin Hong, Jong Ho Moon, Jin-OH Kim, Joo Young Cho, Moon Sung Lee Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Republic of Korea; Department of Internal Medicine, Soonchunhyang University School of Medicine, Seoul, Republic of Korea Backgrounds: The various endoscopic procedures are performed for the treatment of postprocedural bleeding after polypectomy. The endoscopic hemoclipping is used most commonly but its cost is expensive. The purpose of this study is to evaluate the feasibility of surgicel® FibrillarTM as an alternative hemostatic agent which is inexpensive and easily used. Methods: Between September 2011 and September 2012, 3254 consecutive patients who underwent the endoscopic polypectomy in colon were reviewed. The hemostatic procedures such as endoscopic hemoclipping or application of surgicel were performed in patient with post polypectomy bleeding. For the confirmation of hemostasis in cases of application of surgicel, the follow-up colonoscopies were carried out in some cases. Results: There were 85 cases (2.61%) of postprocedural bleeding after polypectomy out of 3254 patients. Of these, 33 subjects (38.8%) underwent endoscopic hemoclipping, while 52 (61.2%) were treated with the application of surgicel. In 48(92.3%) cases from those of immediate bleeding, hemostasis was achieved successfully but delayed bleeding was occurred in one (2.1%) case out of these 52 cases and controlled with endoscopic hemoclipping. The follow-up colonoscopies were performed in 23 cases out of 52 patients who were treated with the surgicel. Conclusions: Endoscopic management of postpolypectomy bleeding by surgicel provides hemostasis in the great majority of cases. Therefore surgicel may use for the hemostasis in patient with colonic postpolypectomy bleeding. For more accurate evaluation of the hemostatic effect of surgicel® FibrillarTM and comparison it to other hemostatic procedures, a prospective study and a larger series of cases are required.