procedures and computed tomography (CT) scans. Methods: This was a retro- spective cohort study using the 2012 National Inpatient Sample (NIS), a nationally representative database of inpatient admissions. Adult patients were included if they had an ICD-9 CM code indicating a diagnosis of gastric bypass surgery. The primary outcome was in-hospital mortality. Secondary outcomes were morbidity measured by shock and intensive care unit (ICU) admission, and resource utilization measured by upper endoscopic procedures, computed tomography (CT) scans, length of stay (LOS), and total hospitalization charges. Patients were divided into two groups based on the presence or absence of marginal ulceration as a secondary diagnosis. A Multivariate regression analysis were used to adjusted odds ratios and means for the following confounders: Age, sex, race, income in patients’ zip code, Charlson Co- morbidity Index, hospital region, location, size and teaching status. Results: A total of 254,650 discharges met inclusion criteria, 12,290 of whom had a secondary diagnosis of marginal ulceration. All adjusted odds ratios, adjusted means and p-values are shown in Table 1. The mean adjusted additional length of stay and total charges were significantly increased for RYGB patients who had a secondary diagnosis of marginal ulceration as compared to those who did not. Furthermore, patients with a secondary diagnosis of marginal ulceration were more likely to have ICU admission and shock, and underwent more upper endoscopies (therapeutic and non-thera- peutic) and abdominal CT scans. Inpatient mortality between the groups did not differ. Conclusions: Hospitalized patients with a secondary diagnosis of marginal ulceration have significantly increased LOS, total hospital charge, ICU admissions, and number of procedures (endoscopies and abdominal CT scans) as compared to those without, regardless of reason for admission. The profound impact of this secondary diagnosis suggests a more aggressive prevention and early treatment plan should be employed for treatment of marginal ulceration. Table 1. Outcomes for RYGB patients with and without a secondary diagnosis of marginal ulceration Adjusted Odds Ratios [95% CI] p- value ICU Admission 1.91 [1.37-2.69] <0.001* Shock (hemorrhagic, septic, cardiogenic) 2.10 [1.58, 2.56] <0.001* In-hospital upper endoscopy 11.11 [10.08, 12.26] <0.001* Therapeutic 4.36 [3.52, 5.39] <0.001* Non-therapeutic 10.49 [9.50, 11.57] <0.001* In-hospital mortality 0.87 [0.58-1.30] 0.486 Abdominal CT scan 1.61 [1.10, 2.34] 0.013* Abdominal MRI 0.55 [0.18, 1.72] 0.302 Chest CT scan 0.58 [0.27, 1.24] 0.158 Adjusted means [95% CI] p-value Adjusted mean additional total charges 15,760 [10,844, 20,676] <0.001* Adjusted mean additional length of stay (days) 2.02 [1.61-2.43] <0.001* Mo1040 Endoscopic Mucosal Resection for Early Esophageal Cancer Is Effective and Safe but the Risk of Recurrence Warrants Continued Surveillance Arvind R. Murali*, Henning Gerke Gastroenterology & Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA Background and Aims: Endoscopic mucosal resection (EMR) is being increasingly used for the treatment of early esophageal cancer (EC). We aimed to study the ef- ficacy, safety and the recurrence rate of EC following EMR. Method: A retrospective cohort study of consecutive patients who received EMR for early EC (T1a and T1b lesions) from 2006 to 2014 was performed. Outcomes measured were complete local remission defined as endoscopic and histologic absence of EC on surveillance endoscopy, adverse events and recurrence of EC following EMR. Results: 79 patients received EMR for early EC. 5 patients were lost to follow up and 3 were awaiting surveillance endoscopy. 71 patients have had complete follow up. Mean age was 69.1 years. 58 (82%) patients were males. 66 (93%) had adenocarcinoma (AC) and 5 (7%) had squamous cell carcinoma (SC). 55 patients were staged T1a. 22 (40%) were T1m2 (lamina propria invasion) and 33 (60%) were T1m3 (muscularis mucosa in- vasion). 33 (60%) were well differentiated, 21 (38.2%) were moderately differenti- ated and only 1 (1.8%) had poorly differentiated EC. 1 patient opted for surgery as definitive therapy. EMR was performed with curative intention in 54 patients. Local remission was achieved in all patients (100%). This required 1 session of EMR in 49 patients, 2 sessions in 4 patients and 3 sessions in 1 patient. Mean follow up period was 36.8 months. 6 (11%) patients had recurrence of EC (Table 1). Average time to recurrence was 13.6 months (range 6-26 months). Five had local recurrence and one had nodal recurrence. Of 49 patients with T1a adenocarcinoma, EC recurred locally in 1 of 28 (3.5%) patients in whom complete BE eradication was achieved with EMR and/or radiofrequency ablation and in 4 of 21 (19%) patients in whom BE eradication was not achieved or attempted (pZ0.15). Three were staged T1a at the time of recurrence and were treated with EMR with complete local remission. Two were staged T1b and received esophagectomy. One patient devel- oped metastatic SC to a left gastric lymph node. This patient had a T1m3 lesion with evidence of lymphovascular invasion at the time of EMR but surgery was not per- formed due to medical comorbidities. 16 patients were staged T1b (submucosal invasion). Ten patients underwent surgery and were cancer free at a mean follow up of 29.7 months. 1 patient had chemotherapy after EMR. Five patients had EMR only because of contraindications for surgery. One had local recurrence of EC at 29 months after EMR. No perforation occurred. Delayed bleeding from the resection site was seen in 1 patient (1.3%). This was treated endoscopically. Conclusions: EMR is effective and safe for the management of early EC. Due to the risk of recurrence continued surveillance is necessary, especially in patients in who Barrett’s metaplasia has not been eradicated. Mo1041 ESD: A Large Single Center Experience in North American Setting Prashant R. Mudireddy*, Poi Yu Sofia Yuen, Kristen Koller, Gregory B. Haber Medicine, Division of Gastroenterology, Lenox Hill Hospital, Summit, NJ Introduction: Endoscopic submucosal dissection (ESD) is dissection of the gastroin- testinal wall along the submucosal layer. It is widely performed in Asia for early esophageal, gastric and colorectal cancers. The primary advantage of ESD compared to endoscopic mucosal resection (EMR) is en bloc resection, more accurate histo- logical assessment and reduced recurrence. It is technically demanding and has increased adverse events, prolonged procedure times compared to EMR. In Western countries ESD is slowly gaining popularity and acceptance. There are very few studies reporting the efficacy, safety and outcomes of ESD in North American setting. Aim: To study the efficacy, safety and outcomes of ESD in a single referral center in North America and compare the outcomes to previously reported large Asian studies. Methods: We performed retrospective review of our endoscopy database. All the ESDs performed by a single endoscopist (G.B.H) between 2008- 2015 were included in the study. En Bloc resection was defined removal of lesion in one piece. R0 resection was defined as en bloc resection with negative horizontal and vertical margins and no lymphovascular invasion. We collected following infor- mation-patients demographics, size of the lesion, location of the lesion, histopa- thology of the resected lesion, en bloc or piecemeal resection, involvement of margins and presence of lymphovascular invasion, adverse events. We routinely admit patients to hospital post ESD, give IV antibiotics and IV proton pump inhib- itors (continuous drip) for 24 hrs post ESD. Categorical data is reported as numbers and percentages. Results: A total of 84 ESDs in 84 patients were included in the study. Average age of the study population was 69 yrs. There was male predomi- nance (69%). Most of the ESDs were performed in stomach (59), followed by esophagus (13) and colorectum(12). The average procedure time was 195 minutes. The average lesion size was 38 mm (range 6-130 mm). Overall en bloc resection rate was 96.4% (81/84) and overall R0 resection rate was 83.3% (70/84). The total adverse events were- 6/84 (7.14%). There were 2 intraprocedural perforations-both were recognized during endoscopy and closed endoscopically using sutures. We had one delayed perforation (1.1%) which was managed conservatively with IV antibiotics. No endoscopic or surgically therapy was needed. There were three significant Table 1. Characteristics of patients who had recurrence after EMR for early esophageal carcinoma Sl no. Age Sex Type of EC Size of EC Histologic stage Histologic differentiation Number of sessions of EMR Time from EMR to recurrence (months) Stage of EC at time of recurrence Treatment for recurrence 1 79 M AC 2-3 T1a, m3 Moderate 2 6 T1a, m3 EMR 2 77 F AC 1-2 T1a, m2 Moderate 1 9.5 T1a, m3 EMR 3 71 M AC < 1 T1a, m2 Well 1 7 T1a, m2 EMR 4 63 M AC < 1 T1a, m3 Moderate 1 26 T1b SR 5 70 M AC < 1 T1a, m3 Moderate 1 21 T1b SR 6 78 M SC 2-3 cm T1a, m3 Moderate 1 12 T0N1 Chemotherapy 7 61 M SC < 1 cm T1b Moderate 3 29 T3N1 Chemotherapy EMR: Endoscopic mucosal resection, EC: Esophageal carcinoma, AC: Adenocarcinoma, SC: Squamous cell carcinoma, SR: Surgical resection. AB438 GASTROINTESTINAL ENDOSCOPY Volume 83, No. 5S : 2016 www.giejournal.org Abstracts