The American Journal of GASTROENTEROLOGY VOLUME 111 | SUPPLEMENT 1 | OCTOBER 2016 www.nature.com/ajg Abstracts S146 Conclusion: In women with risk factors for a difcult colonoscopy, TD positioning was associated with a signifcant reduction in time to the splenic fexure, and can be considered in female patients with risk factors for a difcult colonoscopy. 315 A Comparison of Various Modalities in Staging Rectal Cancer: DRE, EUS, and MRI Jubeen Moaven, MD, Bryan Sauer, MD, Grace E White, RN, Andrew Wang, MD, Vanessa Shami, MD. University of Virginia, Charlottesville, VA. Introduction: Accurate pre-treatment staging of rectal cancer is critical to determine the need for neo- adjuvant chemoradiation therapy (CRT), which is ofered for patients staged as T3 or TxN1 disease or worse. Along with digital rectal examination (DRE), both EUS and MRI are commonly used in clinical practice to evaluate tumor depth (T stage) and locoregional lymph node involvement. Tis retrospective review aims to evaluate the utility and clinical impact of EUS and MRI as adjuncts to DRE for the staging and management of newly diagnosed rectal cancer. Methods: Rectal cancer cases from January 2014 through June 2016 where MRI was performed as part of staging and/or where T-stage assessment by surgical DRE was documented prior to endoscopy were reviewed. All EUS procedures were performed by two experienced ultrasonographers. DRE was per- formed by one of two colorectal surgeons. Kappa statistics was used to measure agreement between diferent staging methods. Tis was done for both T-stage and treatment stage, defned as ≤T2, N0 versus ≥T3 or TxN1 as this dichotomy ofen dictates treatment with CRT. Results: T-stage by DRE was documented prior to EUS in 58 cases. T-stage agreement between DRE and EUS was moderate (K=0.46), with substantial agreement in treatment stage between the two (K=0.64). EUS difered with DRE on treatment stage in 3 cases (5%): 1 was upstaged from T2 to T3 and 2 were down staged from T3 to T2. T-stage by DRE was documented prior to MRI in 45 cases. Agreement between DRE and MRI in both T-stage and treatment stage was modest (K=0.09 and K=0.23 respectively). T-stage by EUS and MRI was documented in 67 cases. Tere was fair agreement for T-staging between EUS and MRI (K=0.29) with greater agreement in treatment stage between the two (K=0.51). EUS and MRI difered on treatment stage in 5 cases (7%): in 3 cases MRI provided a higher stage while in 2 cases EUS provided a higher stage. T-stage and treatment stage agreement across all three staging modalities was modest (0.24) and moderate (K=0.46) respectively (Table 1). Conclusion: DRE performed by an experienced colorectal surgeon correlates well with EUS in determin- ing the stage of rectal cancer and the need for neoadjuvant therapy. Te more modest correlation between DRE and MRI may be due to the smaller sample size. EUS and MRI generally agree on the treatment stage of rectal tumors. Te use of both modalities rarely alters clinical decisions in the treatment of newly diagnosed rectal cancer and is likely redundant. 316 Assessment of Efcacy and Tolerance of Tree Solutions for Small Bowel Preparation for Video Capsule Endoscopy Tomas Geisler, DO 1 , Arslan Talat, MD 2 , Adam Riordan, DO 3 , Kevin Castillo, DO 4 , Milan Dodig, MD 5 . 1. St. Joseph Medical Center, Sharon, PA; 2. Western Reserve Health Education/NEOMED, Youngstown, OH; 3. Lake Erie College of Osteopathic Medicine, Erie, PA; 4. LECOM, Erie, PA; 5. North East Ohio Gastroenterologists, Warren, OH. Introduction: Wireless video capsule endoscopy (VCE) is a useful noninvasive method for visual exami- nation of small bowel mucosa with indications including obscure gastrointestinal bleeding, iron def- ciency anemia, Crohn’s disease, and small bowel tumors. One of the short-comings of VCE, however, is poor visualization of mucosa due to enteric secretions and bubbles obscuring the image. Tere is a great deal of debate about the appropriate preparation for VCE. Despite the current studies and recom- mendations, there has been no clear recommendation as to the best mode of small bowel preparation for VCE. Studies have also yet to investigate the use of sodium picosulfate, magnesium oxide, and anhy- drous citric acid (Prepopik), as it has showed favorable patient satisfaction and improved visualization in colonoscopies. Methods: Tirty-nine patients who met exclusion and inclusion criteria (Figure 1) were randomized into 3 preparation groups: clear liquid diet (CLD), 10oz of magnesium citrate (MC), and one packet of Pre- popik followed by 12oz of clear liquid (full colonoscopy dose is 2 packets). Tirty-fve patients completed the study with one patient excluded because the capsule was retained in the stomach. Patients completed a questionnaire the morning afer the preparation to analyze tolerability. Te endocopists were blinded from the study and completed a form regarding the preparation quality. Te non-parametric Kruskal Wallis Test was used to analyze the questionnaires. Results: No statistically signifcant diference in the quality of preparations both qualitative (Table 1) and quantitative was found. Prepopik had a mean of 19% (9.4) of images obscured; MC had 22.9% (10.8), and CLD had 23.6% (7.5), p-value = 0.506. Tere was also no signifcant diference in patient [315A] Figure 1. [316A] Figure 1. [316B] Figure 2. [316C] Figure 3.