Mo1439 Safety and Efficacy of Moderate Sedation in Obese Patients Undergoing EndoScopic Retrograde Cholangiopancreatography for Suspected Choledocholithiasis Parit Mekaroonkamol*, Mehul Parikh, Ravi Vora, Stephen H. Berger, Emad S. Qayed Gastroenterology, Emory University, Atlanta, GA Endoscopic Retrograde Cholangiopancreatography (ERCP) is one of the most technically demanding procedures in gastrointestinal endoscopy. It carries the highest complication rate of almost 5%. Most common indication for ERCP is suspected choledocholithiasis, a condition commonly affects obese patients, who are at increased risk of sedative complication. Propofol is preferred during elective ERCP as it can provide faster induction and shorter recovery time compared to conscious sedation. However, routine anesthesiologist-assisted deep sedation may not always be available or cost-effective. This study aims to evaluate the safety and efficacy of moderate sedation for obese patients undergoing ERCP for suspected choledocholithiasis.A retrospective case-control study evaluating all ERCPs performed for suspected choledocholithiasis during January 1 2011 and September 1 2014 in our institution was conducted. Out of a total of 63 ERCPs, 29 (46%) were performed for patients whose body mass index (BMI) was more than 30 with 10 (16%) procedures were performed for morbidly obese patients (BMI O 35). Majority of the population studied were AfricanAmerican (86%) and female (90%) with a mean age of 36 years old. Among ERCPs for obese patients, 55% were performed using moderate sedation with fentanyl or meperidine and midazolam, while the other 45% were performed with general anesthesia. There was no direct correlation between increased BMI and selected method of sedation. There was no statistically significant difference in complication rate between two methods of sedation (odds ratio 0.14; 95% CI 0.01-3.18, p Z 0.22). No sedative-specific complications were observed in both groups. The technical success rate was lower in moderate sedation group (62.5%) compared to general anesthesia group (92%) however, this difference was not statistically significant (OR 7.2; 95% CI 0.7-70.2, p Z 0.08). Reasons for failure were inability to cannulate the duct (43%), inability to extract the stone (43%), and patient’s intolerability to sedation (14%).Moderate sedation is a safe and viable mean of sedation in obese patients undergoing ERCP for suspected choledocholithiasis. However, despite its non-statistical significance, the lower success rate in moderate sedation group is concerning and larger prospective trials are warranted. We believe that inadequate sedation and patient’s movement contributed to higher technical failure rate. Obesity alone cannot determine the proper method of sedation. Overall risk and complexity of the procedure need to also be taken into consideration. Mo1440 The Pure Endoscopic Drainage of Pancreatic Pseudocysts in Children a Safe and Eficient Method Case Series Marcel Tantau*, Alina Mandrutiu, Alina Tantau Gastroenterology, Regional Institute of Gastroenterology and Hepatology Cluj Napoca, Cluj -Napoca, Romania; “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania; 4rd Medical Clinic, Cluj-Napoca, Romania Background: Few data are available on the long term efficacy of endoscopic treatment in children with blunt pancreatic injuries. Aim: to evaluate the efficacy and long term results of endoscopic drainage in pediatric patients with pancreatic pseudocysts at a tertiary care referral center. MM the mean size 111.25mm.The procedures were performed under general anesthesia and radiology by the same endoscopist physician.In all patients were performed transgastric drainage with stenting (1-3 pigtail prosthesis) and in one case it was needed transpapilary drainage to, by the major and minor papilla sfincterotomy .In all cases the procedures were successful, none of patients underwent surgical drainage.Mean follow-up after treatment is 10.5 months .All the patients had substantial improvement of symptoms after endoscopic treatment. The pseudocyst were successfully drained and did not reappeared during follow.up.The stents were endoscopically removed after the imaging examination had showed the pseudocysts resolution. Conclusions: Even though, our series of pediatric patients is not very large, we consider that the endoscopic treatment of pancreatic pseudocyst can be a safe and effective treatment with good results on long-term among children to. AB420 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5S : 2015 Mo1441 EUS-Guided Biliary Drainage: Single Center Study for the Assessment of Short and Long Term Outcomes Mouen Khashab*, Mohamad H. El Zein, Ahmed Abdelgelil, Vivek Kumbhari, Saowanee Ngamruengphong, Sepideh Besharati, Alan H. Tieu, Anthony N. Kalloo Johns Hopkins Medical Institute, Baltimore, MD Background: EUS-guided biliary drainage (EUS-BD) has emerged as an alternative to traditional radiologic and surgical biliary drainage procedures after failed ERCP. Aims: To study 1) the safety and efficacy of EUS-BD at one U.S. center where all procedures were performed by one gastroenterologist in the endoscopy unit, 2) long term procedural-related outcomes and 2) predictors of complications. Methods: Consecutive jaundiced patients with malignant biliary obstruction who underwent EUS-BD after failed ERCP at one tertiary academic center between 2011 and 2014 were included. Follow-up consisted of monitoring for adverse events and repeat LFTs. Clinical success was defined as drop in bilirubin by 50% at 2 weeks or to below 3 (level that allows patients to undergo chemotherapy) at 4 weeks. Adverse events were graded according to the ASGE lexicon’s severity grading system. Results: A total of 46 patients (age 61yrs, female 20, pancreatic cancer 30) underwent EUS-BD (Antegrade stenting 3, Rendezvous 6, choledochoduodenostomy 24, Hepatogastrostomy 12, Hepatojejunostomy 1) (Table 1). Reason for EUS-BD was obscured ampulla by invasive cancer or enteral stent (28), surgically altered anatomy (9), failed deep biliary cannulation (9). Most (nZ44, 96%) patients had distal biliary strictures. Mean pre-procedural bilirubin was 13.8 10.5 mg/dL. Electrocautery was used for biliary access and bilioenteric fistula dilation in only 4 (8.6%) cases. Cholangiography was successful in all 46 (100%) cases. Stent placement in desired location (technical success) was achieved in 40 (87%) cases (plastic stent 4 and metallic stent 36). A total of four patients were lost to follow-up. Clinical success was achieved in 34/36 (94.4%, intention to treat; 81% per protocol analysis). Bilirubin (mg/dL) decreased significantly after R 4 weeks (14.6 vs 1.41, p!0.0001). A total of 9 complications occurred in 9 (19.5%) patients: cholecystitis (nZ1), cholangitis (nZ3), peritonitis (nZ1), biliary leak (nZ3), and sepsis (nZ1): 4 were graded as mild, 6 moderate, and 1 severe (cholecystitis). No predictors of complications were found. During long-term follow up, 25 (56.5%) patients died because of disease progression with patent stents after a mean of 165 days; 19 patients remain alive with patent stents at a mean follow up of 294 days. One patient experienced recurrent biliary obstruction due to incomplete stent expansion 2 days after stent deployment, and one patient experienced stent migration at 113 days. Conclusion: EUS-BD is an effective procedure after failed ERCP whether it is performed via intrahepatic or extrahepatic route. The approach should be individualized for each patient based on the endoscopist’s experience and patient’s anatomy. Adverse events are not uncommon but rarely severe. Devices tailored for EUS-BD are needed to improve the safety of the procedure. Table 1. Patient and procedural characteristics EUS-guided biliary drainage (n[46) Age, mean SD 60.7 13 Female, n (%) 20 (43.4) Pancreatic Cancer, n (%) 30 (65.2)