Purpose: To evalaute if the use of tegaserod in patients undergoing capsuleendoscopy would improve the quality of the images and allow the capsuleto reach a more distal segment of the GI tract.Methods: Patients undergoing capsule endoscopy were offered the alter-native of taking Tegaserod, a 5-HT4 receptor partial agonist concommitantto the study. All patients came in after at least a 12 hour fast and underwentthe normal process of electrode placement and endcoscopic capsule inges-tion. The patients who agreed to take the tegaserod were given the 6mg pillwith a small amount of water and then thye followed the routine instruc-tions given to patients undergoing the procedure . They returned 8 hourslater to have the equipment removed. The videos obtained were analyzedto assess the quality of video the images as well as GI transit time as ameasure of the gastric emptying time calculated by the computer softwarewith capsule locator capabilities and compared to the studies of patientswho did not take the tegaserod. The image qualilty was evalauted by a blindphysician.Results: Fourteen patients were invited to participate in the study. Of the14, only four agreed to take Tegaserod before undergoing the wirelessendoscopy study. Among the 14 patients, 12 were female (86%) and 2 male(14%). Ages ranged between 25 to 82 years old ( mean age, 58). Thepatients who took Tegaserod had an average gastric emptying time of 29.25min compared to an average gastric emptying of 104.5 minutes in the groupthat underwent the regular study. The overall visibility of the gastrointes-tinal mucosa was considered of much higher quality in the four cases donewith the use of tegaserod. There were no study related complications ineither group.Conclusions: Peristalsis in the GI tract can vary from person to person andsometimes fasting alone is not enough to guarantee quality pictures inwireless endoscopy studies, secondary to secretions and residual food.Tegaserod is a safe and well tolerated medication that used concommitantlycan increase the quality of the images obtained while at the same timeincreasing the amount of bowel that can be visualized by allowing thecapsule to reach more distal segments of the GI tract than with normalpersistalsis. Its use should be routinely considered in patients undergoingwireless endoscopy since the absolute contraindications for both is thesame, suspicion of bowel obstruction.

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DOES CO2 INSUFFLATION FOR COLONOSCOPY IMPROVEPRODUCTIVITY OF THE ENDOSCOPY UNIT? APROSPECTIVE, RANDOMIZED, DOUBLE BLINDCONTROLLED TRIALMario A. Garza, M.D., Delbert L. Chumley, M.D., FACG*, J. ThomasSwan, M.D., FACG, Patrick A. Masters, M.D., FACG,Fred H. Goldner, M.D., FACG, Michael K. Bay, M.D., FACG.Gastroenterology Consultants of San Antonio, San Antonio, TX.

Purpose: The current demand for endoscopic procedures in this countryhas resulted in efforts to try to increase the utilization and productivity ofendoscopy units. Using CO2insufflation for colonoscopy reduces postpro-cedure abdominal distention and pain. If patients have less abdominaldistension and pain postprocedure, then they possibly can be dischargedsooner. The purpse of the study is to determine if using CO2 insufflationduring colonoscopy will shorten recovery time and, potentially, increaseutilization of the endoscopy unit.Methods: Five hundred consecutive patients undergoing colonoscopy wererandomly assigned in a double blind fashion to either CO2 or air insuffla-tion. Patients were discharged using standard criteria for the endoscopy

unit. Patient demographics, postprocedure pain scores, findings, and dis-charge and procedure times were recorded.Results: Demographics were similar in both groups including age, gender,and sedation/analgesia dosage. Incidence of transient hypoxemia and bra-dycardia were similar in both groups (8 in CO2 and 5 in air group). Fourpatients in the CO2 group had post-colonoscopy pain (3 mild, 1 moderate)compared to 26 in the air group (15 mild, 11 moderate) for p value of�0.001. The mean discharge time for the air group with pain was 34 mincompared to 23 min in the CO2 group (p � 0.1174). Average dischargetime for all patients in the CO2 group was 30.3 minutes compared to 31.2minutes for the air group which was not statistically significant. Averageprocedure time for the air group was 15.1 min compared to 13.9 min for theCO2 group which is statistically significant ( p � 0.02) and remainssignificant when adjusted for age and gender. Age correlated positivelywith procedure time in the air group (r � 0.22, p � 0.001) and negativelywith discharge time (r � -0.13, p � 0.04).Conclusions: 1) Although CO2 insufflation during colonoscopy is bettertolerated by patients as evidenced by less postprocedure pain, CO2 insuf-flation did not significantly decrease discharge times. 2) Although therewas a time difference in discharge of approximately 11 min between thosewith pain in the CO2 vs the air group, this was not statistically significant,probably related to the small number in the CO2 group. 3) CO2 insufflationduring colonoscopy may be helpful in older patients by shortening both theintra-procedure and discharge times, potentially improving an endoscopyunit’s productivity.

922

EUS-GUIDED FNA VS. CT-GUIDED FNA FOR DIAGNOSIS OFSUSPECTED PANCREATIC NEOPLASIAStephen Willis, M.D., Richard Zubarik, M.D.* University of Vermont,Burlington, VT.

Purpose: To compare diagnostic accuracy of CT-guided and EUS-guidedFNA for suspected pancreatic neoplasm.Methods: All patients undergoing pancreatic FNA with CT or EUS guid-ance between 1996 and 2003 were included. All procedures were per-formed with a cytopathologist present. A 22-gauge needle was used withboth procedures. Information was collected regarding age, gender, biliaryobstruction and size and presence of a pancreatic mass on CT.Results: A total of 107 patients underwent FNA. Overall, 72% ultimatelywere diagnosed with pancreatic neoplasia. These included adenocarcinoma(n�73), cystadenoma (n�2), and neuroendocrine tumors (n�2). Meanmass size on CT imaging was 38mm for CT/FNA and 15mm for EUS/FNA. The sensitivity, specificity, negative predictive value (NPV), positivepredictive value (PPV), and accuracy for the two procedures were as below.EUS/FNA was significantly more accurate for lesions 1cm or less(p�0.025). There were 11 false negatives with CT and 6 with EUS.

NSensitivity

%Specificity

%NPV

%PPV%

OverallAccuracy

%Accuracy

<�1 cm %

CT-FNA 53 73 100 52 100 79 50EUS-FNA 54 83 100 75 100 89 89*

* p�0.025

Conclusions: EUS/FNA is at least as accurate as CT/FNA for the diagnosisof pancreatic neoplasm. The accuracy of EUS/FNA is significantly greaterthan that of CT/FNA for lesions 1 cm or less.

S307AJG – September, Suppl., 2003 Abstracts