Tu1555 Impact of Needle Type and Gauge on the Performance of Endoscopic Ultrasound-Guided Sampling: A Meta-Analysis Young Oh* 1 , Jeffrey L. Jackson 2,1 1 Medical College of Wisconsin, Milwaukee, WI; 2 Clement J. Zablocki VA Medical Center, Milwaukee, WI Background: There has been discordant data in the literature regarding which type and size of needle used for endoscopic ultrasound (EUS)-guided sampling has superior performance characteristics. AIM: The aim of this study was to comprehensively review and summarize the available literature on the performance of EUS-guided sampling based on the type and size of needle (19 gauge Trucut as well as 19, 22, and 25 gauge fine needle aspiration [FNA] needles) as well as sampling location. Methods: Published manuscripts until September 2011 regarding the use of EUS FNA or Trucut needles were identified in PubMed using relevant search terms. A review of the references from retrieved articles and abstracts from gastrointestinal meetings was also performed. Only studies that were published in English and compared two or more needles were included. Two reviewers independently reviewed each study for suitability to be included in the analysis. Data was pooled using a random effects model with variance based on exact binomial methods. Accuracy, sensitivity and specificity with 95% confidence intervals were calculated. Results: Forty-one articles and abstracts that included 3905 patients were identified that met the inclusion criteria. The combination of the Trucut needle and 22 gauge needle if necessary yielded the highest accuracy (0.95, 95% CI 0.93-0.97, p = 0.03) and the 22 gauge needle alone yielded the lowest accuracy (0.76, 95% CI 0.72-0.80, p = 0.001). A trend toward higher accuracies with the 25 gauge needle was observed, which did not reach statistical significance. The sensitivity using the Trucut needle was statistically worse than others (0.68, 95% CI 0.60-0.78, p = 0.001) and no significant differences in specificity were observed with any of the needles. There appeared to be no differences by specific site of biopsy. Conclusions: The use of the Trucut needle in combination with the 22 gauge needle if necessary yielded the highest accuracy. For the use of single needles, a trend toward the highest accuracy was observed with the 25 gauge needle but this did not reach statistical significance. Accuracy (95% CI) Sensitivity (95% CI) Specificity (95% CI) Trucut 0.76 (0.71-0.82) 0.68 (0.60-0.78) 0.98 (0.93-1.0) 19 gauge 0.85 (0.75-0.94) 0.94 (0.89-0.99) 22 gauge 0.76 (0.72-0.80) 0.81 (0.76-0.87) 0.96 (0.91-1.0) 25 gauge 0.88 (0.83-0.93) 0.93 (0.90-0.97) 0.97 (0.95-0.99) Trucut  22 gauge 0.95 (0.93-0.97) 0.90 (0.86-0.94) 0.99 (0.95-1.0) 19 and 22 gauge 0.87 (0.77-0.98) Tu1556 Endoscopic Ultrasound Restaging of Gastric Cancer Following Neoadjuvant Therapy Predicts Survival James J. Farrell* 1 , Raman Battish 1 , Jonathan L. Wong 1 , Zev Wainberg 2 , Fritz Eilber 3 1 Medicine - Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, CA; 2 Medicine -Hematology & Oncology, University of California, Los Angeles, Los Angeles, CA; 3 Surgical Oncology, University of California, Los Angeles, Los Angeles, CA Background: There is a resurgent role for endoscopic ultrasound (EUS) in the staging of gastric cancer due to its value in selecting patients with locally advanced disease for neoadjuvant therapy (MAGIC Trial, Cunningham et al, NEJM 2007). There is also an emerging interest in EUS for assessing response to therapy to decide upon continued treatment, change in treatment, or surgery. The aim of this study was to assess the predictive value of a 2nd look restaging EUS in gastric cancer after neoadjuvant therapy. Methods: Patients undergoing EUS for gastric cancer before and after neoadjuvant therapy at UCLA from 2005- 2011 were studied. Downstaging was defined as an objective decrease in EUS T stage after neoadjuvant therapy. Survival was defined as the date of the initial endoscopic ultrasound to the date of death or last follow-up. Downstaging by EUS was correlated with survival using Kaplan Meir and Chi Square analysis (p 0.05 is significant). Results: 20 patients with locally advanced gastric cancer (T2(1), T3(18), T4(1)) underwent EUS evaluation prior to and immediately after neoadjuvant chemotherapy. 9 were defined as having a downstaging response based on improvement in EUS T stage. Response based on EUS T downstaging was associated with improved overall survival, compared with patients who were not downstaged on followup EUS (H.R. = 8.573 (95% CI 2-32, p=0.0025) (Figure 1). Conclusions: Response to treatment as defined by downstaging of T stage by EUS after neoadjuvant therapy correlates with improved survival. The incorporation of pre and post neoadjuvant endoscopic ultrasound in treatment protocols for locally advanced gastric cancer can help physicians predict survival and alter treatment regimens in patients with a poor initial response. Tu1557 Prospective Evaluation of the Incidence of Pancreatic Cysts in Outpatient EUS Patients Diane Settles*, Mohammad A. AL-Haddad, Julia K. Leblanc, John M. Dewitt, Gregory A. Cote, Stuart Sherman, Lee Mchenry Gastroenterology, Indiana University, Indianapolis, IN The prevalence of pancreatic cysts reported varies from 1.2-7% in cross-sectional imaging studies up to 24% in autopsy series. The purpose of this study was to identify the frequency of pancreatic cysts 2 mm in size in patients undergoing EUS for non-pancreatic indications. We hypothesized the true prevalence is between 1.2-24%.In this prospective cohort study, patients 18 years old referred for elective outpatient EUS were considered. Exclusion criteria: 1. referral for evaluation of suspicion of pancreatic cyst, mass, abnormal radiograph or dilated main pancreatic duct (MPD) by clinical history or previous imaging within the previous 3 months; 2. previous upper GI tract or pancreatic surgery; 3. laboratory and/or clinical evidence of acute pancreatitis within the previous 3 months; 4. pregnancy, incarceration, high risk for sedation,coagulopathy/ thrombocytopenia. Study patients underwent EUS examination of the pancreas using a linear or radial echoendoscope. Results of previous cross-sectional imaging and characteristics of pancreatic cysts identified by EUS (defined as any cyst 3 mm in size with or without MPD communication) included: size, shape, location, wall size and presence of any septations, mural nodules or associated mass. EUS-FNA was performed if any of the following were identified: cyst 15mm in size, thickened septation, mural nodule, or a distinct associated mass. Between 9/09 and 9/11, 220 patients were consented, 4 were excluded and 216 were enrolled. Thirty-four were withdrawn secondary to an incomplete pancreatic EUS exam (n=18), EUS not indicated (n=10) or incompletely study information recorded (n=6). Of the remaining 178 patients (52% male, mean age: 61 years), 17 pancreatic cysts were identified in 14 patients (6.4% per ITT and 7.7% per protocol). The None of the EUS procedures were performed for abdominal pain or evaluation for possible chronic pancreatitis. These 17 cysts were a median 6 mm (range: 3-80) in maximal diameter and located in the pancreatic head (n=5), body (n=7) and tail (n=5). Only one cyst was  2 cm. Pancreatic duct (PD) communication was identified in 10 and unable to be evaluated in two. Two of the cysts had a cyst wall thickness 1mm. One cyst was associated with a mural nodule and pericystic mass. Four of the cyst had septations identified; one cyst had a thickened septation 3mm. Two of 17 cysts (12%) underwent EUS-FNA including: 1) 8 cm malignant mucinous cystic neoplasm in a patient referred for evaluation of a suspected a gastric subepithelial tumor and; 2) 15 x 10 mm cyst.Four of these 14 patients with pancreatic cysts detected by EUS had previously negative prior CT or MRI exams. In this preliminary review of an ongoing study, the incidence of pancreatic cysts in outpatients undergoing EUS was 7.7%. The majority of the cysts identified were small and did not require FNA. Tu1558 Randomized Trial Comparing the Fanning and Standard Techniques for EUS-Guided FNA of Solid Pancreatic Mass Lesions Ji Young Bang, Jessica Trevino, Jayapal Ramesh, Shyam Varadarajulu* Gastroenterology-Hepatology, University of Alabama at Birmingham, Birmingham, AL Background: While the standard technique of FNA involves sampling one area within a lesion to procure tissue, the fanning technique involves sampling of multiple areas. This randomized trial compared the standard and fanning Figure 1 Overall Survival: EUS downstage vs no EUS downstage. Abstracts www.giejournal.org Volume 75, No. 4S : 2012 GASTROINTESTINAL ENDOSCOPY AB445