endoscopic findings. Methods: A review of 400 consecutive patients whopresented to our ER with acute GI bleeding from Jan. 2009 to Dec. 2010 wasperformed using a prospectively maintained endoscopic database. Patients whopresented with melena or hematochezia were included, whereas those withhematemesis were excluded to minimize bias in favor of ER physicianassessment. ER physician prediction as to source of bleeding was performedprior to laboratory testing. Endoscopy was performed within 24 hours ofpresentation in all patients. Data were abstracted for patient demographics,laboratory studies, and definitive endoscopic findings. Inter-rater agreement anddiagnostic performance of ER physician assessment vs. BUN/Cr ratio for upperGI bleeding source were compared against endoscopic findings. Strength ofagreement was assessed using the Landis and Koch’s criteria for kappa statistics.Results: Ninety-eight (48 men; mean age 69.6 � 13.3 years) of the 400 patientsevaluated met the inclusion criteria. A prior history of GI bleeding was found in28 (29%) patients. There were 55 (56%) patients on NSAIDs and 43 (44%)patients on PPI at the time of presentation. A total of 48 (49%) patients presentedwith melena, whereas 50 (51%) patients had hematochezia. The mean Hgb was10.7 � 2.4 g/dl, mean BUN was 26.3 � 16.8 mg/dl, and mean Cr was 0.98 �0.39 mg/dl. A total of 48 (49%) patients had an upper GI bleeding source,whereas 50 (51%) patients had a lower source according to endoscopic findings.Inter-rater agreement between ER physician assessment and BUN/Cr ratio wasfair with � � 0.24. The sensitivity, specificity and positive predictive value (PPV)for physician prediction of an upper GI bleeding source were 94%, 88% and88%, respectively. The sensitivity, specificity and PPV of the BUN/Cr ratio forpredicting an upper GI bleeding source were 35%, 100% and 100%, respectively.Overall accuracies of ER physician assessment and BUN/Cr ratio for predictingan upper GI bleeding source were 91% and 68%, respectively. Conclusion: Therewas only fair agreement between ER physician assessment and BUN/Cr ratio inpredicting an upper GI bleeding source. ER physician assessment was moresensitive, less specific, and more accurate than the BUN/Cr ratio for prediction ofan upper GI bleeding source.

Sa1475Endoscopic and Medical Therapies for Angiodysplasias andGAVE: a Systematic Review and Meta-AnalysisEric Swanson*2, Amar Mahgoub2, Aasma Shaukat11Minneapolis VA medical Center, Minneapolis, MN; 2University ofMinnesota, Minneapolis, MNBackground & Aims: Bleeding angiodysplasias and gastric antral vascular ectasia(GAVE) cause significant morbidity and mortality. There are few publishedcomparative studies on treatments and harms. Our goal was to conduct asystematic review on endoscopic and medical therapies for GAVE andangiodysplasia regarding efficacy of treatment on clinical outcomes andcomplications. Methods: A PubMed search was performed for published studiesin English through November 2012, with greater than 5 patients bleeding fromangiodysplasia or GAVE, treated with endoscopic or medical therapies. Measuredoutcomes included: hemoglobin levels, transfusion requirements, rebleeding rate,complications and overall and cause-specific mortality. Results: 61 studies metinclusion criteria: 52 were endoscopic (n� 1628) and 9 were medical treatment(n�261). Eleven studies used comparators, and the results are in Table 1.Compared to conservative therapy estrogen with progesterone showed nodifference in bleeding episodes per year (0.7 vs. 0.9), and an increase incomplication rate (45% vs. 14%, P�.01). Octreotide showed a higher percent ofpatients who were free of rebleeding at 1 and 2 years versus placebo (77% vs.68% and 55% vs. 36%, P�.03), a higher rate of complications (53% vs. 14%,P�.01), and no observed mortality. Thalidomide showed a larger change in thenumber of bleeding episodes per year versus iron therapy (-8.96 vs. -1.38,P�.01) but also had a higher rate of complications (73% vs. 35%, P�.01), withno observed mortality. Compared to conservative therapy argon plasmacoagulation (APC) did not improve the percent of patients free of rebleedingfrom angiodysplasias at 1 or 2 years versus placebo (87% vs. 73%, and 74% vs.52%, P�.06) and had a 9% complication rate. Endoscopic band ligation has notbeen tested against conservative therapy but showed a higher percent of patientsfree of rebleeding from GAVE when compared to APC (92% vs. 32%, P�.01),and a lower mortality rate (16% vs. 32%). Conclusions: There was insufficientevidence to evaluate efficacy of most medical and endoscopic treatmentmodalities. Treatment with estrogen with progesterone showed no improvementin rebleeding rates with increased complications. Treatment with octreotide andthalidomide showed improved rebleeding outcomes and no observed mortality.Among endoscopic therapies, endoscopic band ligation showed a lower rate ofrebleeding compared to APC. Further randomized controlled studies are neededto inform the question.

Sa1476Clinical Characteristics and Outcomes of Gastric VaricesSubtypes in Patients Treated With Endoscopic Injection ofTissue AdhesivesXiaoqing Zeng1, Shiyao Chen*1,2, Lili Ma2, Jingjing Lian2, Bing Wu1,Jie Chen1

1GI & Hepatology, zhongshan hospital, fudan university, Shanghai,China; 2endoscopy center, zhongshan hospital, fudan university,shanghai, ChinaBackground and Aims: The incidence of gastric variceal bleeding is lower thanthat of esophageal varices. However, Bleeding from GV is often severe and fatal.Although endoscopic injection of gastric varices with cyanoacrylate has beenused for the treatment of acute gastric varices bleeding, there is still few dataavailable on characteristics and follow-up of different gastric varices subtypes inpatients treated with tissue adhesives. This study was conducted to evaluateoutcomes of endoscopic injection of tissue adhesives for different subtypes ofGVs. Methods: The study was conducted with a retrospective cohort of patientswith history of esophagogastric variceal bleeding within 15 days. All patients hadboth gastric and esophageal varices. GV were subdivided as follows: GOV1(Group A, extension of oesophageal varices along lesser curve) and GOV2(Group B, extension of oesophageal varices towards fundus). Tissue adhesiveswas injected after being diluted in 1:1 ratio with Lipoidal injection. Patientsconcomitantly with esophageal varices accepted esophageal band ligation orSclerotherapy. Assessed outcomes included rebleeding, complications andsurvival. Results: A total of 903 patients with esophagogastric varices bleedingpresented to our hospital from 2007/1 to 2012/6. 301 patients(33.33%) with bothesophageal and gastric varices were enrolled. GOV1 (Group A) were found in126 patients(41.9%) and GOV2 (Group B) in 175 (58.1%). The differencebetween the two groups was insignificant in sex, age, etiology of portalhypertension, Child-pugh class, ascites, portal vein thrombosis, HCC andtreatment sessions. Form of esophageal varices, size of GV, Portal hypertensivegastropathy were significant different between the two groups. Endoscopicinjection were successfully performed in all patients. The dosage ofcyanoacrylate was higher in GOV2 than in GOV1 (1.9 vs. 1.8, p�0.019). Onepatient in GOV1 group presented with acute cerebral infarction after thetreatment, then healed after active rescue. 39 (12.9%) lost visit (13%,16 in GroupA, 23 in Group B, p�0.556). Early rebleeding within 30 days occured in10patients (7.9%) in GOV1 and 14 (8%) in GOV2 (p�0.337). Over a medianfollow-up period of 10 months (range 1-55 months), in the GOV1 group 20(15.9%) patients bled, in contrast to 43 (24.6%) in the GOV2 group. There wasno difference in re-bleeding-free rates between two groups. 14 (11.11%) patientsdied in Group A and 43 (24.6%) in Group B. A significant difference in theoverall mortality was observed between two groups (p�0.012). On multivariateanalysis,presence of HCC has significant correlations with rebleeding (p�0.033)and mortality (p�0.000). Conclusion: GOV2 patiernts had worse treatmentoutcomes than GOV1 patients. HCC was still the important independentindicators of rebleeding and death.

Clinical characteristics and follow up of patients with gastric varices

Clinical characteristicsGOV1 (Group A)

N�126GOV2 (Group B)

N�175 p

Sex(male/female) 89/37 122/53 0.938Mean age(yr) 56.1�1.1 54.6�1.1 0.341Etiology of portal hypertension (HBV/

alcoholic/others)90/6/30 121/8/46 0.888

Ascites 47 (37.3%) 72 (41.1%) 0.736Child-Pugh score 7.75 7.96 0.199Child-Pugh class(A/B/C) 26/53/47 29/83/63 0.559Association of HCC 29 (23.1%) 42 (24.0%) 0.469Main portal vein thrombosis 14 (11.1%) 15 (8.6%) 0.285Form of Esophageal varices (F1/F2/F3) 10/6/110 39/18/118 0.000Diameter of gastric varices (�1cm/1-

2cm/�2cm)25/78/23 18/72/85 0.000

Portal hypertensive gastropathy 13 (10.3%) 37 (21.1%) 0.018Amount of cyanoacrylate(ml) 1.8�0.36 1.9�0.023 0.019Treatment session(one time/more

than one time)77/49 112/63 0.328

Follow-up(month) 9.88�0.92 11.02�0.92 0.390Lost 16 (12.7%) 23 (13.1%) 0.556RebleedingShort time rebleeding (within 30 days) 10 (7.9%) 14 (8.0%) 0.337Long time rebleeding 20 (15.9%) 43 (24.6%) 0.065Bleed-related mortality 11 (8.7%) 25 (14.3%) 0.475Overall mortality 14 (11.1%) 43 (24.6%) 0.011

Abstracts

www.giejournal.org Volume 77, No. 5S : 2013 GASTROINTESTINAL ENDOSCOPY AB219