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Background and Aims EUS-guided portal pressure gradient (EUS-PPG) measurement is a novel method to evaluate portal hypertension severity. In this study, we determined the consistency between EUS-PPG and hepatic venous pressure gradient (HVPG) measurements in patients with acute or subacute portal hypertension. Methods Twelve patients were prospectively enrolled. EUS-PPG measurements were performed using a 22-gauge FNA needle and a central venous pressure measurement monitor. The HVPG measurements were performed using the transjugular approach. If an HVPG measurement was not attainable and the patient underwent transjugular intrahepatic portosystemic shunt (TIPS) treatment, a PPG was recorded as a reference standard during the procedure. We assessed the feasibility and safety of EUS-PPG and calculated the correlation between the 2 measurements. Results EUS-PPG measurements were successful in 11 patients (91.7%). Subsequent HVPG measurements failed in 2 patients with Budd-Chiari syndrome (hepatic vein occlusion subtype), 1 of whom underwent TIPS treatment to obtain transjugular PPG data. A small shunt was found during 1 HVPG measurement that introduced inaccuracy. Nine patients were included in the statistical analysis. Mean EUS-PPG and HVPG/PPG (transjugular) were 18.07 ± 4.32 mm Hg and 18.82 ± 3.43 mm Hg, respectively. Pearson’s correlation coefficient between the 2 methods was .923 (P Conclusions EUS-PPG measurement using a 22-gauge FNA needle was a safe and accurate method to evaluate portal hypertension and has the potential to supplement the measurement of HVPG in liver diseases. (Clinical trial registration number: ChiCTR1800017317.)

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the prevention of post-ERCP pancreatitis (PEP) is still controversial.We performed a meta-analysis to evaluate the efficacy and safety of NSAIDs for PEP prophylaxis.We systematically searched PubMed, EMBASE, Web of Science, and the Cochrane Library for relevant studies published updated to June 2012.Meta-analysis.Patients undergoing ERCP.NSAIDs use for the prevention of PEP.Overall incidence of PEP, incidence of moderate to severe PEP, and adverse events.Ten RCTs involving 2269 patients were included. Meta-analysis showed that NSAID use decreased the overall incidence of PEP (risk ratio [RR], 0.57; 95% CI, 0.38-0.86; P = .007). The absolute risk reduction was 5.9%. The number needed to treat was 17. Heterogeneity among the studies was substantial. However, after removing the main source of heterogeneity, the prophylactic efficacy was similar (RR, 0.53; 95% CI, 0.41-0.68; P.001). NSAID use also decreased the incidence of moderate to severe PEP (RR 0.46; 95% CI, 0.28-0.75; P = .002). The absolute risk reduction was 3.0%. The number needed to treat was 34. No differences of the adverse events attributable to NSAIDs were observed.Inclusion of low-quality studies, different type and route of administration of the NSAIDs, study heterogeneity, inconsistent use of pancreatic stenting.Prophylactic use of NSAIDs reduces the incidence and severity of PEP.

Su1303 Comparison of Bowel Preparation Quality With a Bowel Purgative Containing Sodium Picosulfate, Magnesium Oxide and Citric Acid Versus a PEG-ELS Solution: A Prospective RCT in China Using Chinese Language Validated Ottawa Scale Yiqi Du*, Yaozong Yuan, Zhizheng GE, Bo Jiang, Minhu Chen, Xiaohua Hou, Xiaoping Zou, Wanmei Wang, Hai Zhang, Zhaoshen LI Dept. of Gastroenterology, Changhai Hospital, Shanghai, China; Dept. of Gastroenterology, Ruijin Hospital, Shanghai, China; Dept. of Digestive Diseases, Renji Hospital, Shanghai, China; Dept. of Gastroenterology, Nanfang Hospital, Guangzhou, China; Dept. of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Dept. of Gastroenterology, Union Hospital, Wuhan, China; Dept. of Gastroenterology, Gulou Hospital, Nanjing, China; Ferring China Development Center, Beijing, China Objective: Colonoscopy (COL) is considered the gold standard for CRC screening and surveillance. Adequate bowel preparation is crucial for a successful procedure. In this study, the efficacy and safety of bowel preparation with a bowel purgative containing sodium picosulfate, magnesium oxide and citric acid (PSMC) and a lowvolume PEG-electrolyte solution (PEG-ELS) were compared in patients requiring COL in China. Methods: This prospective, randomized study included 300 patients undergoing COL, randomly assigned to two doses of PSMC or one dose of 2 L PEGELS (n 150, 50%). PSMC was administered in a split-dose regimen, with the first sachet dissolved in 150 mL of water taken in the evening before the procedure and the second sachet 4-6 hours prior to COL. PEG-ELS was dissolved in 2 L of water and consumed in within an hour, 4 hours prior to COL..The study was conducted in accordance with ICH-GCP. All the patients gave consent before the trial. Bowel preparation quality was assessed by blinded investigators trained in using the Ottawa Bowel Preparation Scale (OBPS), a simple and objective rating that had been translated and validated into Chinese with high inter-observer reliability (kappa ICC: 0.88; 95% CI: 0.80-0.94). The OBPS evaluates the cleanliness of each of the three colonic segments and overall fluid retention. The total OBPS score is calculated by adding the ratings for each colon segment and the fluid quantity rating. A lower OBPS score indicates a better preparation quality. A standardized patient questionnaire was used to evaluate acceptability, tolerability and complications of the regimens. Results: No significant differences were found in the bowel preparation quality between PSMC and PEG-ELS regimens, as judged by the total OBPS (4.76 vs 4.92, NS). In the assessment of overall fluid retention, the PSMC treated group had a tendency to be superior but not to a statistically significant level (0.49 vs 0.62, P 0.06). Patients who took PEG-ELS reported significantly more nausea (49% vs 20%), vomiting (20% vs 3%) and general malaise (49% vs 30%) than those who took PSMC (P 0.001). Moreover, patients also found PEG-ELS more difficult to ingest, less acceptable and less palatable than PSMC (P 0.0001). Conclusion: This is the first RCT in China where PSMC was compared against lowvolume PEG-ELS using Chinese language validated OBPS. PSMC demonstrated equivalent bowel preparation quality to that of PEG-ELS. Furthermore, despite that a low-volume PEG-ELS was used in this study, patients still found PEG-ELS more difficult to take due to its sheer volume and taste, and experienced more discomfort than those who took PSMC. This study provides further evidence that PSMC is a bowel purgative that achieves an ideal balance in providing effective colonic cleansing and patient friendliness in bowel preparation prior to colonoscopies. (NCT 01356407).