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ISCHEMIC JEJUNAL STRICTURES PRESENTING ASABDOMINAL PAIN AND VOMITING IN A 71 YEAR OLDWOMAN: USUAL SYMPTOMS, UNUSUAL DISEASEAjay Bansal, M.D., Joseph Anderson, M.D.* and Edward Cheng, M.D.Division of Gastroenterology, University hospital at Stony Brook, StonyBrook, NY.

Introduction: A 71 year old woman with the past medical history signif-icant for Asthma, s/p Fempop Bypass who presented with 3 day history ofperiumbilical abdominal pain with vomiting. Medications included albu-terol, prednisone, Norvasc and Nexium. Examination revealed an elderlyobese female with mild diffuse abdominal tenderness. CT scan revealed athickened segment of small bowel in LUQ with inflammatory soft tissuechanges. Pt felt better and was discharged. Four weeks later she came backwith the same symptoms. A repeat CT again showed thickening of thesmall bowel without inflammatory changes. Subsequently, the enteroscopyrevealed a smooth stricture without any inflammation at 120 cms. Anarteriogram showed complete occlusion of SMA just beyond its origin withatherosclerotic changes in the aorta and a moderate narrowing at the originof the celiac artery. Surgical resection identified 2 stenotic areas; one was6 CMS long and 1 foot distal and second one 16 CMS long and 3 feet distalto ligament of trietz. Pathology showed extensive fat necrosis, a calcifiednodule, chronic inflammation and evidence of vascular occlusion andrecanalization but no venous thrombosis. Post op the patient did well withresolution of symptoms.Discussion: Ischemic small bowel stricture is a rare disease. The stricturescan be secondary to Crohn’s, NSAID’S, neoplasm, tuberculosis and rarelyischemia. Our search on jejunal strictures revealed only 19 ischemicstrictures.They were secondary to superior mesenteric vein thrombosis (4jejunal, 1 ileal), multiple cholesterol emboli (2, both jejunal), traumainduced ischemia (1 jejunal, 3 ileal), intermittent strangulation of hernias(5)and 3 were unexplained. Out of the 5 cases of SMA thrombosis, one hadantithrombin III deficiency and was on OC’s and the other had Factor VLeiden and protein C deficiency.The strictures due to ischemia can bedifficult to distinguish from other causes. Histologically, the lesions showdiffuse non specific chronic inflammatory infiltrate with a number ofhemosiderin laden histiocytes. The mucosa and submucosa show severecongestion with some evidence of vascular occlusion. Presence of sid-erophages and hemorrhages with absence of granulomas and fistulae maypoint to ischemia as an etiology.

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COMPARISON OF WIRELESS CAPSULE ENDOSCOPY (M2A™)WITH PUSH ENTEROSCOPY IN THE EVALUATION OFOBSCURE GASTROINTESTINAL BLEEDINGRamona M. Lim, M.D., Colm J. O’Loughlin, M.B. and Jamie S. Barkin,M.D. FACG*. Division of Gastroenterology, University of MiamiSchool of Medicine/Mount Sinai Medical Center, Miami, FL.

Purpose: Investigation of obscure gastrointestinal bleeding (OGIB) isoften difficult due to limitations of conventional studies in the detection ofsmall bowel disorders. Wireless capsule endoscopy (CE) is a novel tech-nology designed to allow complete visualization of the small bowel to aidin the diagnosis of small intestinal lesions. We performed a prospective,blinded study comparing the diagnostic yield of CE versus push enteros-copy (PE) in patients referred for OGIB.Methods: From September 2001 to March 2002, we prospectively exam-ined 20 consecutive patients referred for evaluation of OGIB who hadundergone recent colonoscopy, upper endoscopy and small bowel serieswithout identifying the bleeding source. Patients with swallowing disor-ders, pacemakers or implantable electromedical devices, and known orsuspected bowel obstruction were excluded. Each patient underwent CE(Given® Imaging M2A™ capsule) followed within 7 days by PE (OlympusSIF–100). Examinations were performed blindly by separate investigators.

Results: Twenty patients (10F:10M), mean age 64 yrs (range 26–81) wereenrolled in the study. No complications occurred. Fourteen of 20 patients(70%) had positive findings in the small bowel on CE including 8 an-giodysplasias, of which 2 were actively bleeding, 4 polyps, 1 celiac spruewith bleeding mucosa requiring surgical ligation, 2 erosions, 1 enteroen-teric anastomotic ulcer, and 2 with active bleeding without an identifiablelesion. CE identified 8 lesions not seen on PE including 4 AVMs, 2erosions, 1 polyp, and 1 distal small bowel anastomotic ulcer. These werelikely beyond the reach of the enteroscope. Conversely, one patient withnegative CE had active bleeding on PE and required small bowel resectionfor control of bleeding from an AVM. A second patient with activebleeding without defined source on CE had a PE which identified an AVMthat was treated with electrocautery.Conclusions: CE is a safe and well–tolerated modality for visualizing thesmall bowel. CE identified potential sources of bleeding in 70%, as com-pared with 45% with PE. Probable bleeding sites were seen in 9 cases,however the clinical significance of these findings and whether they are thesource of the OGIB remains to be determined by further studies andlong–term follow–up.

LIVER

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THE INITIAL LAPAROSCOPIC APPEARANCE CAN PREDICTRESPONSE TO COMBINATION THERAPY IN HEPATITIS CJasmohan S. Bajaj, M.D., Enrique Molina, M.D., K. R. Reddy, M.D.,Eugene R. Schiff, M.D. and Lennox J. Jeffers, M.D.*. Medicine, SUNYDownstate Medical Center, Brooklyn, NY and Hepatology, Center forLiver Diseases,University of Miami, Miami, FL.

Purpose: Histologic fibrosis predicts a poor response to combinationtherapy in hepatitis C and laparoscopic evaluation of the liver decreases thesampling errors associated with histology alone. Our aim was to study if theinitial laparoscopic appearance of the liver was an additional predictor ofresponse to combination therapy with interferon and ribavirin in hepatitisC.Methods: A retrospective review of 112 naive hepatitis C patients, withoutother causes of liver disease, who underwent diagnostic laparoscopy beforestarting combination therapy with interferon and ribavirin for at least 24weeks and a 24–week post treatment follow up period, was performed. Thegroup was divided into responders and non–responders based on virologicclearance at end of treatment and 6 month post treatment follow up.Demographics, genotype, pre therapy HCV RNA, histologic and laparo-scopic appearance were analyzed. (M/F: 1.3/1; mean age 50 �10 years; 51white, 45 Hispanic and 16 African American patients)Results: 93 (83%) of patients had genotype 1 and the mean pretreatmentHCV RNA was 3.2 � 2.8 million copies/ml (40 (35.7%) had HCV RNA �2million copies/ml). 37 (33%) had laparoscopic cirrhosis while histologi-cally only 30 (26.4%) were cirrhotic. Patients were treated with interferonand ribavirin (mean dose 10.6�2.5 mg/kg); 43 patients were treated for 24weeks (early termination in 36 for no response and 7 for complete re-sponse), 10 patients were treated for 36 weeks (all failed to respond afterinitial response) and 59 patients were treated for 48 weeks. The meanduration of treatment was 37.7�11.4 weeks. Sustained response was ob-served in 26 (23%) of patients, 12 (11%) were only biochemical responderswhile 59 (53%) and 15 (13%) were non–responders and relapsers respec-tively. Univariate logistic regression revealed that the initial laparoscopicappearance (p�0.034) and genotype (p�0.002) were significant factors,which meant that lesser extent of fibrosis on laparoscopy and genotypesother than 1 were predictive of a sustained response to combinationtherapy.Conclusions: The initial laparoscopic appearance by itself and genotypeare significant predictors of a sustained response to combination therapy inhepatitis C. Laparoscopy and histology are complementary for the diag-nosis of cirrhosis in hepatitis C.

S83AJG – September, Suppl., 2002 Abstracts