Sa1133 Predictive Value of Endoscopic Diagnosis of Antral Inflamation. Correlation With Histology Grace Chan, Thanusha Ananthakumar, Ronald Myint, Ashling Walsh, Ion Cretu, Orla F. Craig, Maire Buckley, Claire M. Smyth, Richard Farrell Introduction: Endoscopic findings such as erythema are frequently labelled as gastritis. Some previous studies have shown reasonable concordance between endoscopy and histology findings while others demonstrate a very poor correlation. Aims: To study the positive and negative predictive values of endoscopic diagnosis of antral gastritis and gastropathy. Method: 400 consecutive patients who underwent an OGD and had at least two antral biopsies were included in the study retrospectively. The endoscopic results were then compared to the histology reports for concordance. Only endoscopic reports of antral gastritis according to the criteria described by the Sydney classification were considered ‘positive for antral gastritis'. Histologically, those reported as acute or chronic inflammation, Helicobacter-associated gastritis, chemical or reactive gastritis, hypertrophic gastropathy, eosinophilic gastritis, lymphocytic gastritis, collagenous gastritis and granulomatous gastritis were regarded as being ‘positive for antral gastritis'. Results: In total, there were 182 male patients and 218 female patients. The median age was 50.5 ± 17.2 years (range 15 to 91). The endoscopic appearance of the antrum was positive for gastritis in 51.0% (204/400) of patients and was negative in 49.0% (196/400) of patients. The percentages of patients with presence of inflammation on histology were similar in those with or without endoscopic gastritis (65.7% vs 60.7%, p=0.303). Of the 17.3% (69/400) patients who were eventually diagnosed and treated for Helicobacter-associated gastritis on biopsy, 55.1% (38/400) had endoscopic evidence of gastritis and 44.9% (31/400) of patients did not, p=0.267. The positive and negative predictive values of endoscopy in predicting histological antral gastritis were 39.3% and 65.7% respectively. Conclusion: The predictive values of the endoscopic appearance in the diagnosis of antral gastritis is extremely poor. An endoscopically non-inflamed antrum is as likely as an inflamed antrum to harbour significant pathology such as Helicobacter pylori. Hence, it is essential to obtain antral biopsies in all patients. Sa1135 Self-Expandable Metal Stents or Surgery in Colonic Obstruction: Which is Better? Shamaila Butt, Kalpesh Besherdas Background Colorectal cancer (CRC) is one of the most prevalent malignancies in the world and is the second most common cancer causing death in the UK. Colonic obstruction is usually a late presentation of this disease and is more characteristic of an advanced and incurable lesion. 40% of CRC present as a surgical emergency with either obstruction or perforation. Emergency presentation is associated with a poorer outcome with a relatively high complication and mortality rate from emergency surgery. Colonic stents is being used for palliation and as a "bridge to surgery" for patients with CRC presenting with bowel obstruction. As published studies include patients with both resectable (bridge-to-surgery colon stenting) and unresectable (palliative stenting) colonic malignancy, specific analysis within the two groups is difficult. Aim and methods The aim was to assess the outcomes in patients presenting acutely with colonic obstruction due to colorectal cancer. All those that were stented or underwent operations to treat obstruction were compared for inpatient stay, complications and mortality. Results A total of 25 patients were identified as presenting with colonic obstruction between 2006 and 2010. 13 were males and age range was 51 to 94. 9/25 patients were stented as a bridge to surgery. Average length of in-patient stay was S-225 AGA Abstracts 22 days. 2/9 failed to decompress and 1 perforated thus requiring emergency surgery. One patient died within 30 days of the procedure due to perforation and continued obstructive symptoms. 6/25 patients were stented only for obstruction with an average length of in- patient of stay 27 days. None of these patients re-presented post procedure to hospital. The remaining 10/25 patients underwent operations when presenting with obstruction. Average in-patient stay was 18 days. None of these represented to hospital bar one who presented within 30 days of operation with abdominal pain. Conclusions Our results indicate that colonic stenting as a bridge for surgery requires longer inpatient stays compared to those undergoing surgery and can present with complications. Those that underwent operative procedures early when presenting with colonic obstruction had a better clinical course. From this study, it can be argued that the outcome of patients undergoing stenting is worse than for operative procedures. We recommend that the decision to place a colonic stent in a patient colonic obstruction from CRC should be taken as part of a multidisciplinary discussion. The surgeon should be on stand-by, in case of failure of stent deployment or complication from endoscopic stenting. A prospective study to answer the question of surgery or stent is required. Sa1136 Increased Fat in Pancreas: A Risk Factor for Post-ERCP Pancreatitis? Bhupesh Pokhrel, Eun Kwang Choi, Kumar Sandrasegaran, Evan L. Fogel, Lee McHenry, James L. Watkins, Gregory A. Cote, Henry A. Pitt, Nicholas J. Zyromski, Stuart Sherman, Glen A. Lehman Aims A previous preliminary study has shown increased pancreatic fat in patients with idiopathic pancreatitis and sphincter of oddi dysfunction. We aimed to determine if increased quantities of pancreatic fat is an independent risk factor for post-ERCP pancreatitis. Methods We conducted a case control study of patients who underwent MRI/MRCP followed by an ERCP at Indiana University Medical Center. Subjects included patients who had an abdominal MRI followed by ERCP no more than sixty days later between September 2003 and January 2011. Case subjects were patients who developed post-ERCP pancreatitis. Control subjects included patients who underwent ERCP without developing pancreatitis who were matched for age, gender and indications of ERCP.(before fat content of the pancreas was analyzed). All MRCP films were reviewed with emphasis on fat content of the head, body and tail of pancreas. Percentage of fat was determined by recording signal intensity in the in-phase (Sin) and out-of-phase (Sout) T1-weighted gradient sequences, calculating the fat fraction as (Sin-Sout)/ (Sin) x2. Results We identified 47 patients meeting study criteria and having PEP, matched with 74 control patients. ERCP controls and post-ERCP pancreatitis patients did not differ with respect to age (41.4 vs. 41.1yrs)[p=0.89], gender (78.7% versus 79.7% females)[p=0.81]and Body Mass Index (25.38 vs 27.96)[p=0.13]. Both groups were similar in terms of pre-existent chronic pancreatitis, history of PEP, pancreatic duct filling, sphinc- terotomy and stent placement. No statistically significant differences were noted with respect to measurements of pancreatic head, body or tail fat or Body Mass Index.[Table 1 and Table 2] Conclusion This study failed to show an association between increased fat content of the pancreas as seen by MRI and post-ERCP pancreatitis. Fat Content in Head, Body and Tail in Post-ERCP Pancreatitis Patients versus Controls Pearson Correlation between mean Body Mass Index and the fat content in head, body and tail Sa1137 Adequacy of Bowel Preparation and Documentation of Bowel Preparation Quality at Index Colonoscopy in the VA Health Care System Tilak Shah, Janet M. Grubber, Steven Grambow, Marcus R. Johnson, Dawn Provenzale, Matthew Maciejewski, Deborah A. Fisher Background and objectives: The quality of bowel preparation (prep) is a major determinant of the diagnostic accuracy of colonoscopy. Although inadequate prep has been reported in 10-75% of patients in randomized and prospective trials, data are lacking regarding prep quality in a representative sample of VA facilities. Our objectives were to determine, in a representative sample of VA facilities at index colonoscopy, the proportion of patients lacking prep quality documentation and the proportion with inadequate bowel prep and, in addition, to identify factors associated with non-documentation of prep quality and inadequate prep. Methods: Data were collected on 2,443 patients aged 50-64 from 25 VA facilities that performed ≧ 500 colonoscopies in fiscal year 2008. Facilities were randomly selected within academic affiliation, geographic region, and local resource strata. We randomly selected 100 patients with no colonoscopy in the prior 10 years, and no diagnosis of colorectal cancer or inflammatory bowel disease from each facility and then abstracted their VA electronic medical records for information on quality of bowel prep. Separate multiple logistic regression models were used to measure the association between each dependent variable and respective a priori sets of potential factors (Tables 1 and 2). Results are reported as adjusted odds ratios (OR) and 95% confidence intervals (CI). Results: Among the 2443 colonoscopies, 476 (19%) were missing documentation of prep adequacy (Table 1). Missing documentation among the 25 facilities ranged from 0 to 70%. Among the 1967 patients with documentation of prep quality, 145 (7%) were reported as inadequate. The proportion of patients at each facility with inadequate bowel prep ranged from 1% to 48%. Factors associated with missing AGA Abstracts