endoscopy is extremely useful to detect non-polypoid neoplasia and is now recommended by the AGA, the British Society for Gastroenterology and the Australian Cancer Council. However, video descriptions of imageenhanced endoscopy for detection of IBD-related neoplasia are rare. We present several illustrative examples. The detection, diagnosis and treatment of all dysplasia - polypoid and non-polypoid - is important in patients with IBD. Early detection can save lives. The video provides important information on the recommended technique to screen for dysplasia in patients with IBD and, more importantly, examples of the difficult to find flat and depressed neoplasms. Sp605 A Solution for the Migrating Stent: Use Of The OTSC Device To Hold Fully Covered Esophgeal Stents In Place Shayan Irani*, Todd H. Baron, Richard A. Kozarek Migration of fully covered self-expandable metal stents (FCSEMS) remains a significant limitation, especially in benign diseases. The lack of a stricture (leaks, fistulae) can further increase the migration rates of FCSEMS. Hemostatic clips are notoriously poor at securing SEMS in place. We describe the use of an over-the- scope clipping (OTSC) device (Ovesco, Tübingen, Germany) to secure the proximal end of FCSEMS [23mm X 155mm Wallflex stent, Boston Scientific, Natick, MA, (case1) and 18mm x 60mm Niti-S stent, Taewoong, Seoul, Korea, Case 2,3)] to prevent migration. Data was collected prospectively on 3 patients who underwent placement of an OTSC device to secure FCSEMS in place from 8/2012 to 11/12. Case 1: 40 YM developed a leak 2 weeks after a vertical sleeve gastrectomy, unsuccessfully treated with an OTSC, FCSEMS and PCSEMS, that migrated. Therefore the proximal end of FCSEMS was secured in place with an OTSC for 10 weeks, leading to closure of the leak. The OTSC was easily cut with argon plasma coagulator (APC) and removed with the SEMS. Case 2: 73 YM developed a retrocardiac abscess after an esophagectomy for esophageal adenocarcinoma. After migration of a FCSEMS, he was treated with a naso-sinus drain and a FCSEMS secured in place with an OTSC which has resulted in resolution of the abscess, removal of naso-sinus drain and is pending stent removal in 4 weeks. Case 3: 79 YF developed a high-grade refractory (to dilations) anastomotic stricture 3 months after esophagectomy for esophageal adenocarcinoma . After spontaneous migration of a FCSEMS, the same stent was secured in place with an OTSC device successfully for 4 weeks to date and is pending removal. The OTSC device has successfully secured FCSEMS in place in all 3 patients for a median dwell time of 6 weeks. There have been no adverse events at placement (3/3) or removal (1/1) of the OTSC device. The OTSC device is pending removal in 2 patients. We therefore conclude that the OTSC device can be used to secure FCSEMS and prevent migration. Using APC to cut the joint of the OTSC device, removal is feasible. However, larger case series are needed to confirm the efficacy and safety of this technique to preclude prosthesis migration. Sp606 Endoscopic Management of Severe Bleeding Encountered at/after Drainage of Pancreatic Fluid Collections Shayan Irani*, Todd, H. Baron, S. Ian Gan, Michael Gluck, Andrew S. Ross, Richard A. Kozarek Background and Objectives: Bleeding is a potentially life-threatening AE that can occur at/after drainage of a pancreatic fluid collection (PFC). Traditionally, after failed endoscopic attempt at hemostasis (balloon-tamponade and cautery), angiographic embolization, and finally surgery have been the next and last resort, respectively, for treatment. We describe our outcomes at endoscopic management of 12 patients from 6/2010 to 6/2012 with severe bleeding at/after drainage of PFC. Twelve patients (8 males, median age 55) underwent endoscopic treatment of severe bleeding encountered at/after (11/1) drainage of symptomatic PFC (7 WON, 5 pseudocysts). Route of puncture was transgastric in 9 and transduodenal in 3 patients.Suspected source of bleeding was arterial in 8 patients and variceal in 4 patients occuring at needle-knife puncture in 7, balloon dilation in 4, and at a tube check in 1 patient. Balloon tamponade and cautery were attempted in 11/12 patients and successful in 5/11 (45%) patients. Self- expandable covered metal stents were used successfully in 2/2 (100%) patients. EUS guided or direct endoscopic cyanoacrylate was used successfully in 4/5 (80%) patients [total endoscopic success 11/12 (92%), median follow up 12 months]. One patient had an associated perforation, managed conservatively, and another patient had partial splenic embolization, without any AE. Median decline in hemoglobin 3gm/dL.One patient had recurrent bleding from pseudoaneurysm. Severe bleeding can be a dangerous problem that can occur at/after drainage of pancreatic fluid collections. After failed balloon tamponade, epinephrine and cautery, self-expandable metal stents, and direct or EUS-guided cyanoacrylate are options available to the endoscopist prior to proceeding to angiography or surgery. Larger prospective series are needed to confer benefit. Sp607 Peroral Endoscopic Myotomy (POEM) With a Novel Submucosal Lifting Gel - Can We Throw the Knife Away? Susumu Shinoura*, Jason B. Samarasena, Kee Don Choi, John G. Lee, Kenneth J. Chang Conventional treatments for achalasia include endoscopic balloon dilation and Heller cardiomyotomy. The initial clinical cases utilizing the POEM technique were published in 2010. We hereby report a POEM procedure on a porcine model using a novel Submucosal Lifting Gel or SLG (Cook Medical), which facilitated a rapid submucosal dissection with minimal bleeding and excellent visibility. After marking the entrance point, pre-injection was performed using normal saline. Submucosal Lifting Gel was injected into the sub-mucosal layer. A mucosal incision was then performed using an Olympus dual knife at the mucosal entrance point.Introduction of the endoscope into the sub-mucosal space was easily achieved without need for electrosurgical dissection. The scope appeared to have a piston effect by pushing the gel distally resulting in further dissection by the gel. In essence, the submucosal lifting gel created a tunnel by “auto-dissection” of the submucosal layer. The myotomy is performed by careful dissection of sling fibers at the cardia of the stomach. The incision was performed across the circular muscular layers.The dissection was gradually and carefully lengthened and deepened to the level of the longitudinal fibers.After successful myotomy, the entrance was closed using endoclips. This animal case demonstrates that using the Submucosal Lifting Gel for POEM procedures has some potential benefits; 1.The submucosal lifting gel appears to “Auto dissect” which would decrease the need for electrosurgical dissection using a knife or needle, 2.The gel appears to have a tamponade effect, thereby minimizing bleeding, 3.The transparency of the gel allows excellent visibility of the submucosal space. Sp608 Successful Mucosal Transplantation from Stomach to Esophagus for Stricture Prevention after Widespread Circular Endoscopic Submucosal Dissection (ESD) For Early Esophageal Squamous Cell Carcinoma - Report of a First Case in Man with 1 1/2 Year Transplant Survival Juergen H. Hochberger* Secondary stricture formation is the major drawback for resections 3 cm or more than 75% of the esophageal circumference at esophageal ESD. In March 2011 we embarked on animal experiments regarding esophageal resection and re-transplantation of esophageal and gastric mucosal patches in pigs under an approved protocol (NLVL No: 33-42502-06/1151) for stricture prevention. CASE REPORT: A 72 y old man with swallowing difficulty (DG1); tabacco use of 20 py until 15 y ago. Prior rectal resection with sigma anus praeter for a T2 distal rectal cancer. EGD: Suspicion of early squamous cell cancer (Paris IIa; EUS UT1a, m, N0), 75% circum-ferential tumor spread within the cervical esophagus and upper sphincter area (17-25 cm aborally). Biopsy: SC HG-IEN. On April 13, 2011 we performed an EGD under general anesthesia with tracheal intubation with first tubular ESD over 10 cm from the lower hypopharynx through the UES from 17-27 cm followed by a 9x4 cm ESD in the gastric antrum. The healthy gastric specimen retrieved was cut longitudinally into 3 mucosal stripes that were attached to the denuded esophageal muscular layer by means of hemoclips. The stripes were gently pressed against the wall by a non-covered self-expanding metal stent with the intent to allow also a luminal nutrition of the specimen. The sphincter area of 1.5 cm length had to be spared. The esophageal specimen showed a non-invasive low horny early squamous cell cancer (pT1a G2 L-, V-) and curative resection (R0; invasion depth of lamina propria max. 150 microns). Stent removal was performed at day 20 and was cumbersome due to local mucosal hyperplasia. However, multiple islets of gastric mucosa had successfully grown at the esophageal resection site. The patient was discharged on day 24 and regularly seen as outpatient. We observed a stepwise circular spread out of the reddish layer over an area of 5-6 cm within the next 6 months. Stenosis was successfully prevented. Biopsy proved antral HP-negative mucosa. 1 1/2 years later the patient is free of complaints. This first case of a successful gastro- esophageal endoscopic mucosal transplant with one year follow-up after wide- spread ESD in the esophagus for an early squamous cell cancer opens a new perspective for systematic research in this field. Sp609 Scanning Fiber Endoscopy: No Longer Driving Blind Adam W. Templeton*, Kevin R. Webb, Joo Ha Hwang, Eric J. Seibel, Michael D. Saunders Indeterminate pancreatico-biliary strictures remain a difficult diagnostic dilemma with currently available endoscopic imaging. We present scanning fiber endoscopy as a novel platform for improving diagnostic accuracy and present three cases where this platform has been used successfully in human subjects. In all three cases, endoscopic retrograde cholangiography was performed using a Abstracts www.giejournal.org Volume 77, No. 5S : 2013 GASTROINTESTINAL ENDOSCOPY AB113