Tu1277 Endoscopic Variceal Ligation (EVL) Is Safe in Cirrhotic Patients With Severe Thrombocytopenia Nithi Thinrungroj, Pises Pisespongsa*, Phuripong Kijdamrongthum, Apinya Leerapun, Taned Chitapanarux, Satawat Thongsawat, Ong-ARD Praisontarangkul Medicine, Chiangmai University, Chiangmai, Thailand Background & Aims: EVL is the treatment of choice for esophageal variceal bleeding (EVB). However post-EVL ulcer bleeding is not uncommon and can cause significant morbidity and mortality. Whether severe thrombocytopenia and coagulopathy really are the risks of post-EVL ulcer bleeding remains inconclusive. We aimed to assess the risk of post-EVL ulcer bleeding in cirrhotic patients with severe thrombocytopenia and coagulopathy in real-life settings. Methods: Cirrhotic patients who had EVL performed for secondary EVB prophylaxis in Chiang Mai University hospital from January 2011 to December 2011 were included. Due to shortage in blood components, we have certain experience in performing EVL in patients with acute EVB who were thrombocytopenic. Hence, we extend this into performing EVL in several patients with severe thrombocytopenia and prolonged prothrombin time (PT). The patients’ demographic, clinical, laboratory and endoscopic data were reviewed. The post-EVL ulcer bleeding was determined and evaluated. Results: One hundred and sixteen patients with 164 EVL sessions were included. Eighty- five were male and 31 were female. There were 13 post-EVL bleeding (7.9%). Severe thrombocytopenia (platelets count  50,000/mm3) was observed in 24 sessions (14.63%) and prolonged PTas PT-INR  1.5 in 24 sessions (14.63%). The proportion of Child-Pugh score class C, active alcohol drinking, propranolol using, large EV, and GV were not different between bleeders and non-bleeders. The platelets count, PT, and hematocrit were also not different between two groups. There were 3 post-EVL bleeding in patients with platelets count  50,000/mm3 (12.5%) compare with 10 bleeding (7.6%) in patients with platelets count  50,000/mm3 (p = 0.408). Surprisingly, there was no bleeding among 6 patients who had platelets count  30,000/mm3 (p = 1.0). The bleeding rate in patients with PT-INR1.5 was also not increased (9% vs 8.5%, p = 1.0) Conclusions: Post-EVL ulcer bleeding was not associated with severe thrombocytopenia and prolonged PT, and the safe platelets count cut-off for EVL may be as low as 30,000/ mm3. The determining risk for bleeding should be looked for beyond just bleeding tendency. The larger scale prospective study is needed to confirm the safety level of platelets count. Tu1278 Short-Term Outcomes of Endoscopic Submucosal Dissection (ESD) for Superficial Esophageal Neoplasms: a Multicenter Survey Yoshiki Tsujii* 1 , Tsutomu Nishida 1 , Naoki Kawai 2 , Katsumi Yamamoto 3 , Shinji Kitamura 4 , Toshiyuki Yoshio 5 , Hideharu Ogiyama 6 , Takeshi Nakamura 7 , Masato Komori 8 , Akihiro Nishihara 9 , Motohiko Kato 1 , Takuya Yamada 1 , Hideki Iijima 1 , Masahiko Tsujii 1 , Tetsuo Takehara 1 1 Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan; 2 Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan; 3 Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan; 4 Department of Gastroenterology, Sakai Municipal Hospital, Sakai, Japan; 5 Department of Gastroenterology, Osaka National Hospital, National Hospital Organization, Osaka, Japan; 6 Department of Gastroenterology, Itami City Hospital, Itami, Japan; 7 Department of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Japan; 8 Department of Gastroenterology, Osaka Rosai Hospital, Sakai, Japan; 9 Department of Gastroenterology, Minoh City Hospital, Minoh, Japan Introduction: Endoscopic mucosal resection (EMR) is widely accepted as a treatment for superficial esophageal neoplasms (SENs).In en bloc resection of larger lesions, however, it has a recognized limitation. In comparison, endoscopic submucosal dissection (ESD) is a promising procedure that enables en bloc resection of larger lesions. In addition to technically-difficult and time- consuming procedure, however, more than half-circumferential ESD sometimes develops esophageal stricture. Recently, good outcomes have been reported from high-volume centers as single-center study, but safety and efficacy have not been evaluated in a multicenter survey of municipal hospitals. Methods: This is a multicenter retrospective study from May 2005 to October 2012 in 9 hospitals attending Osaka Gut Forum. A total of 256 SENs in 214 patients (174 male, median age 69 yrs) treated with ESD were enrolled, and the incidence of complications: perforation including mediastinal emphysema, postoperative pneumonia, bleeding, and esophageal stricture, were estimated. Results: Mean tumor size was 20.412.0mm. Over half SENs (59%) were located in the middle thoracic esophagus, and the depressed type (65.5%) was predominant. The pathological diagnoses of the invasion depth were as follows; dysplasia/LGIN 5.6%; HGIN/EP 48.6%; LPM 23.3%; MM 14.5%; SM1 (200m) 2.8%; SM2 or deeper 5.2%. The en bloc resection rate was 96.5%, and 216 lesions of them (84.4%) were completely resected with negative margins. Perforation, postoperative pneumonia, esophageal stricture occurred in 17 (6.6%), 3 (1.2%), and 6 (2.3%), respectively, whereas no postoperative bleeding was observed. Dividing between the two consecutive study periods (before December 2009 and after then), we found that perforation rate significantly decreased [11.1% vs. 3.8%, p=0.025], and that the proportion of over 3cm lesions treated by ESD significantly increased [8.3% vs. 17.3%, p=0.045]. Both rates of complete resection and curative resection also increased from 81.6% and 76.5% to 86.6% and 77.7%, respectively, after January 2010. Conclusion: Esophageal ESD had its characteristic complication, such as high risk of stricture and low risk of postoperative bleeding. This multicenter-study of municipal hospitals indicated that esophageal ESD was increasingly feasible with acceptable complication risks through recent advances in instrument and skill. Tu1279 A Survey of Expert Follow-up Practices After Successful Endoscopic Eradication Therapy for Complicated Barrett’s Esophagus Aarti O. Bedi*, Richard S. Kwon, Joel H. Rubenstein, Cyrus R. Piraka, Grace H. Elta, James M. Scheiman, B. Joseph Elmunzer Gastroenterology, University of Michigan, Ann Arbor, MI Background: Despite the rising number of patients undergoing endoscopic eradication therapy for Barrett’s esophagus (BE) with high-grade dysplasia (HGD) or intramucosal cancer (IMC), there is a paucity of data to guide clinical decision-making and research initiatives surrounding post-treatment surveillance and follow-up. We aimed to define expert practice patterns regarding follow-up after endoscopic treatment of complicated BE in order to provide an expert- based clinical framework on which the endoscopy community may model its practice while awaiting evidence-based guidelines, as well as to identify important and timely research questions pertaining to this aspect of care. Methods: A 21-item web-based survey instrument was developed and distributed to 48 endoscopists with expertise in BE endotherapy. The survey included multiple choice and table-based questions inquiring into follow-up practices after successful endoscopic treatment of complicated BE. The survey instrument was designed by two investigators and subsequently iteratively pilot tested by the remainder of the authors in order to establish face and content validity and to improve factors affecting test-retest reliability, such as the clarity and order of questions, length of the instrument, and ease of administration. Results: Forty- two of 48 (87.5% response rate) expert endoscopists completed the survey. Respondents’ self-reported annual number of BE treatment procedures ranged from 11-20 per year (12% of respondents) to 100 per year (31% of respondents). After treatment of BE with HGD or IMC, all experts perform surveillance upper endoscopy, most commonly at 3 month intervals in the first post-treatment year, every 6 months during the second year, and annually thereafter. During surveillance EGD, approximately 90% of respondents perform routine biopsies of the neo-squamous epithelium and 93% of experts perform routine biopsies of the normal-appearing Z-line. None of the experts perform surveillance EUS after successful treatment of HGD, and only 19% perform EUS after treatment of IMC. After cancer eradication, 40% of experts refer patients for CT scan, and 30% of experts refer patients for PET scan. Thirty-eight percent of experts refer patients for a surgical opinion when IMC extends into the muscularis mucosa; 100% refer when IMC extends into submucosa. Conclusions: For patients who have undergone successful endoscopic eradication therapy of Barrett’s esophagus with HGD or low-risk IMC, experts uniformly perform follow-up upper endoscopy. Only 19% of experts perform surveillance EUS, and a minority refer patients for CT scan or PET scan. Additional research is necessary to establish optimal surveillance intervals, the role of follow-up EUS, CT, and PET, as well as the surgical implications of low-risk IMC extending into the muscularis mucosa. Abstracts AB484 GASTROINTESTINAL ENDOSCOPY Volume 77, No. 5S : 2013 www.giejournal.org