AGA Abstracts and EGD. CONCLUSIONS: EV screening with CE and EGD both appear cost-effective. Since CE is sensitive to multiple factors including its cost, test characteristics, and the prevalence of EV further studies should be directed towards accurate measurements of these values. However, the decision regarding which strategy to use likely will be based on patient and provider preference. M1127 A Standardized Bowel Preparation Regime Can Improve Completion Rates and Quality of Study in Capsule Endoscopy Jonathan C. Macdonald, Victoria Porter, Deirdre McNamara INTRODUCTION: Capsule endoscopy (CE) is an established technique for investigating diseases of the small bowel, but studies to date suggest that diagnostic yield is often reduced by poor luminal views and incomplete small bowel transit at the time of battery expiry. Published data shows that between quarter and half CE's performed without prep are incomplete (1,2). Although many preparation regimes have been tried to overcome these problems, there is no consensus regarding optimal preparation for CE. AIM: To determine if standardized bowel prep for CE improves completion rates and study quality compared to reported statistics. METHODS: Our departmental protocol for CE preparation comprises: Day -2; Low residue diet (LRD) Day -1; 2 sachets sodium picosulfate based laxative Day -1; Fast from 22.00h Day 0; CE 08.30h Reports from 103 consecutive CE's, performed to the above protocol, were retrieved from our capsule endoscopy database. All reports had been ‘dual read' by the same two members of staff (VP, DM). Reports were audited and completeness of examination, adequacy of luminal views, and small bowel transit time (SBTT) were assessed. RESULTS: 103 cases were reviewed, all patients tolerated prep, and there were no adverse events. Indications were obscure occult GI bleeding (n= 30), obscure overt GI bleeding (n= 38), anemia (n= 12), suspected small bowel crohn's (n=10), assessment of celiac disease (n=2), diarrhea (n=5), others (n=6). In 92/103 CE's (89.3%) transit through the small intestine (SI) was confirmed by identification of cecal mucosa (n=89) or capsule exit from ileostomy (n=2). There were no cases of permanent capsule retention. There was one case of device failure. Luminal views were satisfactory or better in 82/92 (89.1%) completed CE's. Of 103 CE's audited, 82 (79.6%) achieved complete examination of the SI with adequate or better mucosal views. The SBTT was recorded for 89/92 (96.7%) completed studies and averaged 3h 35mins (range 25m - 6h 52m). CONCLUSION: Our data shows that bowel prep with LRD and sodium picosulfate laxative achieves higher completion rates (89.3%) and improves visualization (89.1% satisfactory views) compared with previously reported figures including studies with no prep or alternative preparations. We advocate the widespread adoption of our protocol as standard practice for preparation for CE. REFER- ENCES: 1) Viazis N, Sgouros, S et al. Bowel preparation increases the diagnostic yield of capsule endoscopy: A prospective, randomized, controlled study. Gastrointest Endosc 2004;60:534-538 2) Dai N, Gubler C, et al. Improved capsule endoscopy after bowel preparation. Gastrointest Endosc 2005;61:28-31 M1128 Prospective Study to Detect Metastases of the Liver By Using Contrast Enhanced Ultrasound: Comparison with Multi-Detector Row Computed Tomography and Superparamagnetic Iron Oxide-Enhanced Magnetic Resonance Imaging Kazuyoshi Nakamura, Taketo Yamaguchi, Taro Hara, Kentaro Sudo, Tadamichi Denda, Hideyuki Takano Objective: New ultrasound contrast agent such as Sonazoid is commercially available in Japan. The aim of this study was to prospectively compare the sensitivity of contrast enhanced ultrasound (CEUS) using Sonazoid, multi-detector row computed tomography (MDCT) and superparamagnetic iron oxide-enhanced magnetic resonance imaging (SPIO-MRI) in the detection of hepatic metastases. Subjects and methods: Twenty-two consecutive patients with findings of extrahepatic primary malignancies (sixteen pancreatic cancers and six colon cancers) before treatment were examined with MDCT, SPIO-MRI and CEUS within a 14- day period in order to search hepatic metastases. CEUS was performed at 10 minutes afer a bolus injection of Sonazoid. MRI was performed before and after SPIO administration, using breath-hold gradient-recalled echo T1-weighted and turbo spin-echo fat-sut T2-weighted sequences. Two radiologist independently evaluated image quality, and the number, location, and diameter of lesions scanned using both techniques. Final confirmation of hepatic meta- stasis was done by hepatic resecton (including intraoperative hepatic sonography) or more than 6-month follow-up after the study. Result: Hepatic metastases confirmed were 46 lesions: SPIO-MRI and MDCT detected 39 and 30 metastases, respectively, while, CEUS using Sonazoid detected 42 metastases. Three lesions that coulud not detected by both SPIO-MRI and MDCT were detected only by CEUS. Conclusion: CEUS using Sonazoid is a sensitive technique for detection of hepatic metastases. CEUS may have a potential role in imaging patients with possible metastatic involvement of the liver. M1129 Primary Sclerosing Cholangitis Is Associated with Endoscopic and Histologic Backwash Ileitis in Patients with Ileal Pouch-Anal Anastomosis Katherine Freeman, Ana E. Bennett, Bo Shen, Rocio Lopez Background and Aims: Primary sclerosing cholangitis (PSC) in patients with underlying IBD has been considered as a unique form of IBD (PSC-IBD), which has been shown to be associated with increased risks for backwash ileitis in patients with pan-ulcerative colitis and pouchitis in patients restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA). We hypothesized that patients with PSC may also have a higher risk for backwash ileitis in the setting of IPAA. The aim of this study was to compare the endoscopic and histologic inflammation scores of the afferent limb and pouch between patients with and without PSC. Methods: 25 IBD and PSC patients with ileal pouches were identified from our prospectively-maintained pouch database and 49 IBD patients without PSC who had A-344 AGA Abstracts IPAA were randomly selected from the database with a 1:2 study:control ratio. Demographic, clinical, endoscopic and histologic variables were analyzed. The Pouchitis Disease Activity Index (PDAI) histologic (range 0 -6) and endoscopic (range 0 -6) scores were used to quantify inflammation of the afferent limb and pouch. Results: There were no statistical differences in age, gender, durations of IBD and pouch, NSAID use between the study and control groups. However, patients with PSC had higher PDAI endoscopic scores of the afferent limb than those without PSC. In addition, patients with PSC had higher PDAI histologic scores of the afferent limb than those without PSC (P = 0.029). Conclusions: Concurrent primary sclerosing cholangitis appears to be associated with backwash ileitis in patients with IPAA, suggesting that the liver condition and/or systemic factors may contribute to backwash ileitis in IBD patients with or without colon. Primary Sclerosing Cholangitis is Associated with Endoscopic and Histologic Bacwash Ileitis in Patients with Ileal Pouch-anal Anastomosis M1130 The Effects of Azathioprine or 6-Mercaptopurine On Birth Outcome in Women with Inflammatory Bowel Disease Lisa S. Shim, Alexander A. Simring, Henry Murray, Guy D. Eslick, Martin D. Weltman Background: The data on the safety of azathioprine (AZA)/6-mercaptopurine (6MP) in pregnancy is limited. There is even less data on its use in childbearing patients with inflammatory bowel disease (IBD). Therefore, it remains controversial whether purine ana- logues should be continued during pregnancy in women with IBD. Methods: Details of pregnant women with IBD were obtained through the Sydney West Obstetrics database from 1996 to 2006. The medical files were retrospectively reviewed and the information collected included maternal's age, smoking and alcohol history, diagnosis and disease activity of IBD, and medications used before and during pregnancy. The birth outcome measures were live births, spontaneous abortions, prematurity (<37 weeks gestation), low birth weight (LBW) at term (<2500g), and congenital defects. The birth outcomes were analysed using t-test comparing the cohort who have been exposed to AZA/6MP during pregnancy to controls who have never been exposed to the drug. Results: 76 pregnant women with IBD were identified. Of these, 15 (Crohn's Disease (CD) 12, Ulcerative Colitis (UC) 3) were exposed to AZA/6MP throughout pregnancy. The remaining 61 (CD 43, UC 18) who did not receive purine analogues represented the control group. The mean maternal age (29 vs 30) and mean gestational age (38 vs 39.3) were similar in both groups. Corticosteroids and 5-aminosalicylate agents were used more frequently in women who were treated with AZA/ 6MP during pregnancy (60% vs 16% ; 73% vs 48%, respectively). Of the 15 patients, only 1 received 6MP (100mg once daily) and the rest were prescribed AZA, doses ranging from 50mg to 200mg once daily. There were 4 of 15 (27%) preterm deliveries in the exposed cohort and 7 of 61 (12%) in the control group (p=0.11). There was 1 congenital abnormality (p=0.58) and 3 spontaneous abortions (p=0.38) in the control group with none observed in the exposed cohort. There was no LBW deliveries at term seen in both cohorts. Placental blood flow during the third trimester of pregnancy was measured using arterial doppler ultrasonography in 4 of the exposed cohort and the results were all normal. Conclusion: These results suggest that the use of AZA/6MP is safe during pregnancy with no increase in adverse birth outcomes. On the contrary, cessation of these drugs during pregnancy in women with IBD may result in risk of relapse and adverse fetal outcomes. M1131 Frequency of Lymphoma in Patients with Inflammatory Bowel Disease (IBD) in An Academic Center David Kotlyar, Wojciech Blonski, Mark Weiner, James D. Lewis, Gary R. Lichtenstein Background: Immune modulators such as azathioprine, 6-mercaptopurine (6-MP), infliximab and Adalimumab are widely used to treat both Crohn's Disease (CD) as well as ulcerative colitis (UC). A recent metanalysis (Kandiel A, et al. Gut 2005; 54(8):1121-5.) demonstrated that the pooled estimated risk of the development of lymphoma in patients with inflammatory bowel disease (IBD) treated with azathioprine or 6-MP was 4.18. It is uncertain is this risk is attributable to the medication use or the disease severity. The aim of the present preliminary study was to evaluate the prevalence of lymphoma in patients with IBD and to characterize the prevalence of differing types of lymphoma at a large academic medical center. Material and Methods: Electronic clinical databases of the University of Pennyslvania Health System were systematically searched for the patients with inflammatory bowel disease using the