Tu1622 Evaluation of Relationship Between Gastroesophageal Reflux Disease (GERD) and Laryngopharyngeal Reflux Disease (LPRD) Yoshihiro Kondo*, Makoto Sasaki, Naotaka Ogasawara, Yasushi Funaki, Mari Mizuno, Akihito Iida, Naohiko Kawamura, Kentaro Tokudome, Yasutaka Hijikata, Shinya Izawa, Ryuta Masui, Yoshitsugi Ito, Yasuhiro Tamura, Hisatsugu Noda, Kunio Kasugai Gastroenterology, Aichi Medical University, Nagakute, Japan Introduction: Gastroesophageal reflux disease (GERD) is defined as a condition that develops when reflux of the stomach contents involving gastric acid juice causes troublesome symptoms. GERD typically presents heartburn and regurgitation, but it can also present atypically as chronic cough, throat pain, and asthma. Atypical symptoms such as chronic cough, throat pain, and asthma are considered to be associated with laryngopharyngeal reflux disease (LPRD). Currently, LPRD is associated with laryngeal irritation such as laryngitis caused by reflux of the gastric acid juice. However, the accurate relationship between GERD, especially endoscopic positive esophagitis (EE) and LPRD is still unknown. In this study, we examined the grades of EE and the larynx findings using esophago-gastroendoscopy, and investigated the relationship between GERD and LPRD. Methods: Four hundred two patients except gastrointestinal malignant tumors, gastrointestinal ulcer, esophageal varices, and usage of proton pump inhibitor or H2-blocker underwent esophago-gastroendoscopy for examining the findings of gastro-esophageal junction, cardiac position of the stomach, and larynx at the Department of Gastroenterology, Aichi Medical University School of Medicine between January 2007 and December 2008. Three otorhinolaryngologists and three gastroendoscopists blindly evaluated the findings of laryngopharyngeal area (edema of inferior position of larynx, redness of aryepiglottic fold, thickness of interarytenoid mucosa, and presence of vocal fold granuloma) and gastro-esophageal junction, respectively. Independent and significant predictive factors of EE (background of patients, symptoms, the laryngopharyngeal findings, presence of esophageal hernia) were determined by multivariate analysis. Results: Thirty patients (7.5%) were diagnosed as EE. Of all patients, 114 (28.4%), 230 (57.2%), 271 (67.4%), and 7 (1.7%) patients harbored edema of inferior position of larynx, reddness of aryepiglottic fold, thickness of interarytenoid mucosa, and granuloma of vocal fold, respectively. One hundred fifteen patients (28.6%) complained of laryngopharyngeal reflux symptoms, but there was no relationship between laryngopharyngeal reflux symptoms, the grades of EE, and the findings of larynx. However, esophageal hernia [odds ratio (OR), 2.6], and thickness of interarytenoid mucosa (OR, 4.9), were independent predictive factors of EE. Conclusion: Although laryngopharyngeal reflux symptoms possessed no statistical relation to the findings of both EE and laryngitis, the thickness of interarytenoid mucosa which might be initially affected by the reflux of stomach contents involving gastric acid juice was exceedingly related to EE.
Tu1623 Concurrent Biodegradable Stent Placement and Single-Dose Brachytherapy Is Associated With an Unacceptably High Complication Rate in the Palliative Treatment of Dysphagia From Esophageal Cancer Meike M. Hirdes*1, Jeanin E. Van Hooft2, Harm Wijrdeman3, Maarten C. Hulshof4, Paul Fockens2, Onne Reerink3, Martijn G. Van Oijen1, Ingeborg Van Der Tweel5, Frank P. Vleggaar1, Peter D. Siersema1 1 Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, Netherlands; 2Gastroenterology & Hepatology, Academic Medical Center, Amsterdam, Netherlands; 3Radiotherapy, University Medical Center Utrecht, Utrecht, Netherlands; 4Radiotherapy, Academic Medical Center, Amsterdam, Netherlands; 5Biostatistics, University Medical Center Utrecht, Utrecht, Netherlands Background and Aim: Both single-dose brachytherapy and self-expanding stent placement are effective palliative treatments for dysphagia. While brachytherapy provides better long term (⬎3 months) relief of dysphagia, stent placement provides immediate improvement. In patients with a relatively good prognosis (life expectancy ⬎3 months), we hypothesized that concurrent treatment with brachytherapy and biodegradable (BD) stent (Ella-CS, Czech Republic) placement could provide both immediate and long term relief of dysphagia. The aim of our study was to evaluate technical feasibility and safety of concurrent, single dose brachytherapy and BD stent placement in patients with esophageal cancer. Methods: From Dec 2009 - April 2011, we aimed to include 20 consecutive patients with dysphagia for at least solid food due to incurable esophageal cancer with an expected survival of ⬎3 months. Patients were treated with 12 Gy brachytherapy on day 1 and BD stent placement on day 2. Patients were monthly followed-up for dysphagia and serious adverse events (SAE), defined as each unexpected event for which endoscopy or admission was indicated. Primary endpoint was an intervention-related SAE, as evaluated by an expert-panel. A pre-defined safety threshold of ⱕ25% intervention-related major complications was considered acceptable, while ⱖ 40% was considered harmful,
necessitating ending of the study. Results: After 19 inclusions, the study was ended prematurely because the safety threshold had been exceeded. Thirteen patients were males; median age was 66 (range 39-87) years. Seven (37%) patients received concurrent palliative chemotherapy. Technical success rate was 100%. In total, 28 SAEs occurred in 17 (89%) patients. No fatal SAEs occurred. Nine patients (47%) developed an intervention-related SAE as determined by the expert panel (severe retrosternal pain and/or vomiting n⫽6, haematemesis n⫽1, recurrent dysphagia n⫽2) after a median of 6 days (range 2- 80). The other 19 non-intervention related major complications also included mostly severe nausea and vomiting (n⫽8) but developed after a median of 63 days (range 34-168, p⫽0.07). No association was found between the administration of palliative chemotherapy and development of nausea and vomiting (2/7 with chemotherapy vs. 6/12 without chemotherapy, p⫽0.63). Although luminal patency was adequate in 17/19 patients, 7 patients could not tolerate a normal diet due to severe nausea and vomiting. Median body weight decreased from 75kg (range 54-88kg) to 67kg (range 49-79kg, p⫽0.005) after 2 months. Median survival was 90 (range 25-300) days. Conclusions: Due to an unacceptably high SAE rate, in particular severe pain, nausea and vomiting, concurrent treatment with brachytherapy and BD stent placement cannot be recommended for the palliative treatment of dysphagia from esophageal cancer.
Tu1624 Predisposing Factors for Candida Esophagitis Kyung-Yup Kim, Jae-Young Jang*, Jun-Hyung Cho Kyung Hee University Hospital, Seoul, Republic of Korea Background; As the prevalence of reflux esophagitis increases, so does the use of gastric acid suppression therapy. Asymptomatic Candida esophagitis is increasing in esophagogastroduodenoscopy patients receiving gastric acid suppression therapy. This study aims to document the relationship between gastric acid suppression therapy and Candida esophagitis. Methods: To investigate the prevalence of Candida esophagitis, we conducted retrospective analysis of 55,314 persons who underwent screening esophagogastroduodenoscopy for medical check-up between January 2006 and December 2010 at Kyung Hee University Hospital in Seoul, Korea. Two hundred patients who were treated for Candida esophagitis between January 2008 and August 2011, and 400 age- and sex-matched normal non-Candida esophagitis patients during the same period were enrolled in this study. BMI, alcohol intake, smoking, cholesterol, creatinine, and gastric acid suppression therapy of patients with Candida esophagitis were compared with those of the control group. Results: The prevalence of Candida esophagitis was 0.35% and was increasing (linear by linear association, p ⫽ 0.001). In the univariate analysis, gastric acid suppression therapy and diabetes were related to Candida esophagitis. In the multivariate analysis, gastric acid suppression therapy (odds ratio (OR) 5.547, confidence interval (CI) 2.517-12.225) and diabetes (OR 2.614, 95% CI 1.2715.374) were related to Candida esophagitis. Conclusions: The results of this study indicate that gastric acid suppression therapy and diabetes are risk factors for Candida esophagitis. This study has some limitations because of its retrospective design. Further prospective studies are necessary to establish the risk factors for Candida esophagitis.
Tu1625 Clinical Impact of Screening for Head and Neck Region and Intervention for Early Head and Neck Squamous Cell Carcinoma in Patients With Esophageal Squamous Cell Carcinoma Hiroyuki Morimoto*, Tomonori Yano, Yusuke Yoda, Hironaga Satake, Atsushi Yagishita, Takashi Kojima, Yasuhiro Oono, Hiroaki Ikematsu, Kazuhiro Kaneko Department of Gastroenterology and GI Oncology, National Cancer Center Hospital East, Kashiwa, Japan Background: The observation of head and neck region using Narrow Band Imaging (NBI) endoscopy is useful for early detection of head and neck squamous cell carcinoma (HNSCC) in patients with esophageal squamous cell carcinoma (ESCC). Furthermore, endoscopic resection (ER) is effective for superficial HNSCC. However, it is not clarified yet that early detection and intervention for early HNSCC in patients with ESCC would decrease the events related to metachronous advanced HNSCC or not. Aim: We comparatively evaluated following events in ESCC patients, 1) detection rate of early HNSCC, 2) lost of laryngeal function and death related metachronous advanced HNSCC, between the periods before and after commencement of screening for head and neck region. Patients and Methods: At the beginning of 2005, we introduced the screening for oral cavity using NBI in patients with ESCC before treatment, and every follow up evaluation. Two groups of patients who fulfill following criteria were set up, 1) newly diagnosed stage II/III ESCC treated with definitive treatment (surgery or chemo-radiotherapy), 2) absence of history or synchronous advanced HNSCC, 3) follow up period is 6 months or longer. Group A (before the commencement of NBI screening) was consist of patients who were treated between Oct-1992 and Dec 2000, and Group B (After the commencement) was
AB468 GASTROINTESTINAL ENDOSCOPY Volume 75, No. 4S : 2012