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Background and Aims The efficacy of palliative biliary drainage by using bilateral or unilateral self-expandable metal stents (SEMSs) for a malignant hilar biliary stricture (MHS) remains controversial. This prospective, randomized, multicenter study investigated whether bilateral drainage by using SEMSs is superior to unilateral drainage in patients with inoperable MHSs. Methods Patients with inoperable high-grade MHSs who underwent palliative endoscopic insertion of bilateral or unilateral SEMSs were enrolled. The main outcome measurements were the rate of primary reintervention for malfunction after successful placement of SEMSs, stent patency, technical and clinical success rates, adverse events, and survival duration. Results A total of 133 pathology-diagnosed patients were randomized to the bilateral group (n = 67) or the unilateral group (n = 66). The primary technical success rates were 95.5% (64/67) and 100% (66/66) in the bilateral and unilateral groups, respectively ( P = .244). The clinical success rates were 95.3% (61/64) and 84.9% (56/66), respectively ( P = .047). The primary reintervention rates based on the per-protocol analysis were 42.6% (26/61) in the bilateral group and 60.3% (38/63) in the unilateral group ( P = .049). The median cumulative stent patency duration was 252 days in the bilateral group and 139 days in the unilateral group. The risk of stent patency failure was significantly higher in the unilateral group (log-rank test; P P Conclusions Unilateral and bilateral drainage strategies by using SEMSs had similar technical success rates, but bilateral drainage resulted in fewer reinterventions and more durable stent patency in patients with inoperable high-grade MHSs. (Clinical trial registration number: NCT02166970.)

Background Esophageal metastasis of hepatocellular carcinoma (HCC) is extremely rare; it was not serially followed-up by endoscopy. Objective Our purpose was to report the endoscopic findings according to the progression of esophageal metastatic HCC. Design Case report. Results In the review of the cases, submucosal tumor or polypoid mass were the most common endoscopic findings, and the locations of esophageal metastatic tumors are variable. The tumors had progressed from a submucosal mass to a polypoid mass in the current case. Limitation Small number of cases. Conclusions The endoscopic findings of esophageal metastasis of HCC may be changed from submucosal mass to polypoid mass.

Su1391 Value of Cytology Combined With Histology by EUS-FNA in the Solid Pancreatic Mass and Intra-Abdominal Lymphadenopathy Tae Hyeon Kim, Young Woo Sohn, Jun Young Lee, Keum Ha Choi, Hyo Jeong Oh Internal Medicine, Wonkwang University Hospital, Iksan, Republic of Korea; Internal Medicine, Wonkwang Unversity Hospital, Sanbon, Republic of Korea; Pathology, Wonkwang University hospital, Iksan, Republic of Korea Background and Aim: Endoscopic ultrasound guided fine-needle aspiration (EUSFNA) is a safe and accurate technique for diagnosing pancreatic tumor. Small core biopsies can be obtained with conventional EUS-FNA. Although most studies have concentrated on the cytology of specimen, few data existed on the histologic assessment. The aim of this study were to determine whether core biopsies by conventional EUS-FNA can increase the accuracy of EUS-guided sampling when combined with cytology when no on-site cytopathologist is present. Method: In the 66 consecutive patients(68 lesions) undergoing EUS-FNA of solid pancreatic masses and intra-abdominal lymphadenopathy between May/ 2009 and July/2010 at a tertiary university hospital without on-site pathologist, adequate tissue coil from the needle were harvested for histology; residual tissue was examed for cytology. The adequacy of sampling, the sensitivities, specificities and overall accuracies of cytology or histology alone and combined cytology-histology were determined. Result: 66 patients ( 38 male and 28 female, mean age 64.9 10.9) with 68 lesions were enrolled. Adequate samples were obtained by EUS-FNA cytology, histology, and combined cytology-histology in 93.8%, 69.2%, 95.4% of patients, respectively. From the pancreas (n 44), adequate samples for histology were obtained by FNA in 78.5%, compared with 52.2% from non-pancreatic cases (n 24), respectively (p 0.01). The significant factors affecting the rate of adequate sample for histology were mass size ( 2cm), malignant lesion, and pancreatic lesion(p 0.05). Overall sensitivity and accuracy of EUS-FNA was 81.9% and 84.6% for cytology alone, 60.0% and 63.1% for histology alone, and 88.2% and 89.2% for combined cytology-histology, respectively (p 0.01, compared to cytology alone). Conclusion: This study shows that combined cytology and histology analysis in diagnosing pancreatic mass and intra-abdominal lymphadenopathy may increase the sensitivity and accuracy of conventional EUS-FNA.

Predictors of Hemostatic Failure After Hemoclip Treatment for Active Peptic Ulcer Bleeding Tae Hyeon Kim, Mi Ryeong Sim, Joo Jin Yeom, Suck Chei Choi, Yong Ho Nah Active bleeding and non-bleeding visible vessel in patients with bleeding peptic ulcer is associated with a high risk of rebleeding. The aim of our study was to define risk factors associated with failure of endoscopic hemostasis and rebleeding in patients with active peptic ulcer bleeding. Method: Ninety-six patients (56 men and 40 women; 58.8 G 15 years) with active peptic ulcer bleeding (spurting, oozing, non-bleeding visible vessel) treated in Wonkwang Medical Center from January 2002 to July 2004 were retrospectively analyzed. They were classified to endoscopic hemoclip (N Z 61) and epinephrine injection plus hemoclip (N Z 35). The clinical outcomes were compared both therapeutic modalities and the factors associated with rebleeding were analyzed. Results: Initial hemostasis was achieved in 79 patients (82.2%), 5 patients needed operations (5.2%), and 4 deaths occurred (4.1%). Recurrent bleeding, the duration of hospital stay, blood transfusion requirements, complication rate, and mortality rate were not statistically different between hemoclip alone and combination group. Univariate analysis showed that rebleeding was significantly related to the presence of shock on admission (p Z 0.04), ulcer size of more than 2 cm (p Z 0.03), hemoglobin level of less than 8 g/dL (p Z 0.001) in all patients. In a multivariate analysis, hemoglobin level of less than 8 g/dL was only positive predictor (OR 6.721, 95% CI 1.617w27.931, p Z 0.009). Conclusion: This results suggest that the combination method does not provide substantial advantage over use of the hemoclip method alone in the hemostatic management of active peptic ulcers bleeding. The presence of shock, low hemoglobin on admission, and ulcer size of more than 2 cm may be useful to predict rebleeding after initial endoscopic hemostasis in patients with active peptic ulcer bleeding. Abstracts