© 2013 by the American College of Gastroenterology The American Journal of GASTROENTEROLOGY Abstracts S439 gested by dense lymphoid aggregate of CD20+, bcl2+ cells with molecular studies positive for bcl2-IgH fusion transcript. Conclusion: The diagnosis of follicular lymphoma is often made by incidental finding on endoscopy, with lesions most often presenting in the duodenum. The diagnosis in small bowel, beyond the duo- denum, remains challenging, especially because tissue sampling is needed to confirm the diagnosis even if it is suspected on imaging or video capsule. Previous reports have demonstrated that DBE is helpful to diagnose malignant lymphoma of the small intestine at earlier stages as well as to diagnose recurrence after lymphoma was in remission. We believe this case represents the first report in the literature of follicular lymphoma diagnosed by SE, proving that SE a highly effective as well as safe modality for diagnosis and staging of small bowel lymphoma. 1482 Novel Use of Endoscopic Clips as Fiducials for Radiotherapy in Small Bowel Lymphoma Vanessa Mendez, MD, 1 Fernando Martinez, MD, FACG, 1 Frederick Soriano, RN, 2 Arnold Markoe, MD, 2 Izidore Lossos, MD, 2 Kunal Saigal, MD, 2 Daniel Sussman, MD, MSPH 3 . 1. University of Miami-Jackson Memorial Hospital, Miami, FL; 2. University of Miami Hospital-Sylvester Comprehensive Cancer Center, Miami, FL; 3. University of Miami Miller School of Medicine, Miami, FL. Purpose: A 31-year-old woman, raised in Chernobyl during the nuclear disaster, presented with non-bloody diarrhea, pyrosis, and abdominal pain. EGD showed multiple sub-centimeter white nodules in the second portion of the duodenum, with biopsies revealing grade 1 follicular lym- phoma. Staging workup limited the disease to the small bowel. The patient underwent radiotherapy; however, on surveillance push enteroscopy, the lymphoma was again identified in the fourth part of duodenum and proximal jejunum. Endoscopic clips were used as fiducials to better localize the tumor during subsequent radiotherapy (1). After repeat radiation simulation, it was noted that a portion of the demarcated lymphomatous mucosa lay outside the previously irradiated field. Again, the patient received radiotherapy (2). The patient achieved complete remission and currently has no evidence of disease on surveillance. Endoscopic clips were developed for hemostasis of GI bleed- ing. They are being increasingly used for other purposes. Several published articles have described endoscopic clips as tools for localization in preoperative and pre-radiotherapy planning in lumi- nal tumors. However, only one prior report exists describing duodenal follicular lymphoma tumor localization using endoscopic clips. In our case, endoscopic clipping was necessary to properly localize the tumor after treatment failure. Endoscopic clips are increasingly being used as tumor localization tools due to their ease of use and favorable risk/benefit ratio. Larger studies should be done to demonstrate their superiority in tumor localization and decrease in treatment and disease- related morbidity. 1483 Water Exchange Colonoscopy without Air Insufation May Facilitate Terminal Ileum Intubation Aung Kaung, MD, 1 Eric Chak, MD, 2 Hartley Cohen, MD, FACG, 1 Gordon Ohning, MD, PhD, FACG, 1 Felix Leung, MD, FACG 1 . 1. Veteran Afairs West Los Angeles Medical Center, Los Angeles, CA; 2. David Gefen School of Medicine at UCLA, Los Angeles, CA. Purpose: We report that colonoscopy without air insufation may facilitate terminal ileum intubation and examination in a difcult case. Case: A 78-year-old male was admitted with melena with hypotension. Hemoglobin level was 11.4 g/dl dropped to 7.5 g/dl with fuid resuscitation, a decrease from baseline of 14 g/dl. EGD did not [1482A] Figure 1. Endoscopic images: one clip placed proximal to duodenal lesion, and 2. clips placed distally to jejunal lesions. [1482B] Figure 2. CT Simulation: The red volume is the gross tumor volume while the magenta represents the Planning Target Volume which accounts for error due to motion and technique. Note the location of the clips acting as fiducials for future radiation.