*S1627 EUS in the Diagnosis and Management of Esophageal Pathology in Children Antonio Quiros, Shiro Urayama There is minimal published data for the use of EUS in the diagnosis and management of UGI pathology in children. We are interested in the utility of EUS during the initial evaluation in children for suspected UGI pathology. Case 1: 17 yo HM with Down’s, ALL and currently under treatment for CNS relapse. Evaluated for a 3 mo hx of recurrent vomiting, abdominal pain and significant weight loss requiring parenteral nutrition. UGI and CT scan showed lower esophageal wall thickening at GE junction with luminal narrowing and proximal dilatation. A 4 mm diameter pediatric endoscope was passed through stricture area revealing a grossly normal gastric fundus and body and confirming the stricture length at 1 cm. Case 2: 2 yo HM with an 18 mo history of poor weight gain, recurrent emesis, feeding dysfunction and aversion to textured foods and solids. PE, developmental history and response supplemental enteral nutrition formula are normal. UGI and CT scan revealed a 2cm x 2cm cystic mass compressing on esophageal lumen with unclear relation to esophageal wall just above GE junction. EGD study showed a luminal protrusion approximately 2 cm above the Z-line which had a bluish hue and was non-pulsatile. On further examination it was noted that a 0.5 cm hiatal hernia existed with mild reflux esophagitis. Case 3: 4 yo CCM with Down’s, poor weight gain due to feeding problems and emesis since infancy. Chronic emesis of ‘‘undigested’’ food noted after solids introduced, esophageal web was suspected during swallow study and UGI revealed a possible indentation in mid-thoracic esophagus suggestive of a mass or external compression. EGD revealed no esophageal web and an indentation 7 cm above the LES which occluded about 50% of the esophageal lumen. An Olympus 20 Mhz ultrasound miniprobe was used to examine the areas of interest. In the first case, the muscularis propria layer around the GE junction was identified measuring 2mm in thickness, ruling out achalasia or any intramural tumor. Prominent mucosal thickening only was noted on the exam. A balloon dilatation was perfomed and this patient went home on liquid diet after 3 days. In our second case, EUS showed a cystic lesion which shared muscular layer with the normal esophagus but had what appeared as a uniform mucosal lining with no septations. In our 3rd case, a clear vascular structure was identified wrapping around the anterolateral wall of the esophagus. These cases illustrate the utility of EUS and suggest its possible role within the management algorithm of UGI pathology in pediatric patients. *S1628 Lymphoma of the Terminal Ileum Presenting as Intussusception and Hematochezia Ramamurti Chandra, Katie P. Miller, Dennis Borochovitz An 8 year old boy presented with a six day history of hematochezia, diarrhea, and sharp, non-radiating periumbilical pain with intermittent nausea and vomiting. He had a 22 pound weight loss over the past month and denied any travel history. Past medical history and family history were unremarkable. He had an uneventful full- term vaginal delivery with normal developmental milestones. Upon admission, he was afebrile, BP 90/60, P 100. Physical exam revealed pallor. Abdomen was soft, nondistended, mild tenderness in the RLQ, hyperactive bowel sounds. Hgb 9.0 g/ dL (nml 14.3-16.0), MCV 76 (nml 80-99), all other labs were normal. EGD showed hiatal hernia and mild esophagitis. CTscan showed a large soft tissue density mass that appeared intraluminal in the ascending colon and hepatic flexure (Fig 1). Colonoscopy revealed a friable ulcerated polypoid lesion protuding out of the ileocecal orifice into the cecum (Fig 2). The patient was then taken to the operating room for exploratory laparotomy, and had an ileocecal resection with primary end to end anastomosis. Pathology revealed malignant lymphoma of the ileum (high- grade, noncleaved, diffuse, large-B cell type) invading through the muscularis propria into the subserosal fat with intussusception of the ileum into the colon (Fig 3). Subsequent work-up revealed a normal bone scan, CT chest, and normal bone marrow biopsy making this a Stage II malignant lymphoma of the ileum. The patient tolerated intrathecal Methotrexate and Cyclophosphamide plus predni- sone, and has since been in complete clinical remission 10 years after treatment. Discussion: Gastrointestinal lymphoma accounts for 4-12% of all non-Hodge- kin’s lymphomas. Primary ileocecal lymphoma is uncommon and thus poorly studied. Patients may present with abdominal pain, altered bowel habits, weight loss, abdominal mass, and/or hematochezia. Approximately, 75% of all cases of intussusception occur in children under 1 year of age, and almost 90% of cases are idiopathic. This is in contrast to the adult population where 80% of intussusceptions are neoplastic. Malignant lymphoma in the terminal ileum tends to cause intussusception because of the polypoid type of lesion with little attachment to the surroundings, and minimal disruption of the muscularis propria. Our patient was unusual presenting in the pediatric age group with a neoplastic cause of intestinal intussusception, in this case a malignant lymphoma. It illustrates the importance of prompt recognition resulting in successful treatment and longterm remission. *M1694 The DAVE Project (Digital Atlas of Video Endoscopy): A New Internet Based Digital Video Atlas for Educational Purposes Brenna C. Bounds, William R. Brugge, Dan Collier, Peter B. Kelsey BACKGROUND: Endoscopy is a visually oriented discipline. Video clips, by virtue of their dynamic nature, provide greater visual detail of gastrointestinal anatomy and pathology than static photographic images. METHODS: Endo- scopic procedures (EGD, EUS, ERCP, DACP, enteroscopy, VCE, and colono- scopy) were digitally captured in real time, edited and correlated with corresponding pathology, radiology and surgery for each procedure. A clinical narrative with salient didactic points was dictated for each completed clip. The finalized video endoscopic clips with audio (EVECAs) were rendered in MPEG-2 format and subsequently converted to RealMedia for on-demand viewing as streaming video via the internet. The user interface is server generated dynamic HTML pages, with a relational database system backend. The DAVE project is intuitively searchable by keyword, index or homunculus. Digital video clips have been submitted online from remote sites for inclusion in the DAVE project. RESULTS: The DAVE project framework is complete. The editor interface for EVECA uploading and indexing is detailed, rapid, and easily modified. The user interface search function is intuitive and versatile. The internet interface is seamless and the video clip resolution is excellent. CONCLUSION: The DAVE project represents the first internet based, fully digital, educational video atlas of gastroenterology which integrates multiple endoscopic imaging modalities with relevant surgical, pathologic, and radiologic data. While many excellent photographic atlases of endoscopic findings exist, the substitution of video clips for still images will provide greater educational benefit. Online submissions are anticipated to significantly augment the scale of the project. The DAVE project may represent an educational milestone for the dissemination of knowledge to the practicing physician, trainee, and student. *M1695 Computer-generated, Digital, Multimedia Database for Colonoscopy Piet C. de Groen, Jung Hwan Oh, Wallapak Tavanapong, Johnny S. Wong Background: Endoscopic procedures are performed by people with variable skill sets, and endoscopic results are interpretations of visual observations by people with variable reference sets. Differences in reference sets are difficult to assess, but differences in skill sets can indirectly be measured as, for instance, average total time per procedure, frequency of intubation of the cecum, and frequency and type of complications. A system to automatically capture and document the findings of endoscopic procedures based on standards using reference information does not exist. Therefore, direct endoscopy to endoscopy or patient to patient comparisons cannot be performed. Goal: To develop a system that allows automatic documentation and extraction of findings for each step of an endoscopic procedure, allows comparison of procedures performed by different operators, and provides quality control as well as educational means to improve procedural skills. Results: We created a capture system that combines the entire video stream of colonoscopy with audio annotation (location information and comments) by the endoscopist, and records this in digital MPEG-2 format. Using this system we created a digital multimedia database consisting of over 200 complete, anonymized, audio-annotated, colonoscopies. Next, we developed an automated video segmentation algorithm that extracts location information (e.g., rectum, sigmoid, etc) and comments using speech recognition and natural language processing from the audio segment of the data stream and divides each MPEG-2 file in up to 13 scenes (rectum, sigmoid, descending, transverse, ascending, cecum, TI, cecum, ... rectum). Subsequently, we applied a new automated algorithm to remove non-informative or blurred images. At present we successfully segment nearly 9 out of 10 colonoscopies, and extract blurry frames, on average 37% of frames, with an accuracy of 95%. Conclusions: We have created a digital multimedia database for colonoscopy, a method to segment digitized multimedia colonoscopy files into anatomic scenes, and a novel algorithm that removes blurry images with high accuracy. Our current system will form the basic infrastructure that will allow us to develop software tools for image analysis, content-based video retrieval and creation of a distributed system able to capture procedure-related information from different geographic locations. P144 GASTROINTESTINAL ENDOSCOPY VOLUME 59, NO. 5, 2004