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The Asia-Pacific Working Group on Inflammatory Bowel Disease was established in Cebu, Philippines, under the auspices of the Asia-Pacific Association of Gastroenterology with the goal of improving inflammatory bowel disease care in Asia. This consensus is carried out in collaboration with Asian Organization for Crohn's and Colitis. With biologic agents and biosimilars becoming more established, it is necessary to conduct a review on existing literature and establish a consensus on when and how to introduce biologic agents and biosimilars in conjunction with conventional treatments for ulcerative colitis and Crohn's disease in Asia. These statements also address how pharmacogenetics influences the treatments of ulcerative colitis and Crohn's disease and provides guidance on response monitoring and strategies to restore loss of response. Finally, the review includes statements on how to manage treatment alongside possible hepatitis B and tuberculosis infections, both common in Asia. These statements have been prepared and voted upon by members of inflammatory bowel disease workgroup employing the modified Delphi process. These statements do not intend to be all-encompassing, and future revisions are likely as new data continue to emerge.

The Asia-Pacific Working Group on Inflammatory Bowel Disease was established in Cebu, Philippines, under the auspices of the Asia-Pacific Association of Gastroenterology with the goal of improving inflammatory bowel disease care in Asia. This consensus is carried out in collaboration with Asian Organization for Crohn's and Colitis. With biologic agents and biosimilars becoming more established, it is necessary to conduct a review on existing literature and establish a consensus on when and how to introduce biologic agents and biosimilars in conjunction with conventional treatments for ulcerative colitis and Crohn's disease in Asia. These statements also address how pharmacogenetics influences the treatments of ulcerative colitis and Crohn's disease and provides guidance on response monitoring and strategies to restore loss of response. Finally, the review includes statements on how to manage treatment alongside possible hepatitis B and tuberculosis infections, both common in Asia. These statements have been prepared and voted upon by members of inflammatory bowel disease workgroup employing the modified Delphi process. These statements do not intend to be all-encompassing, and future revisions are likely as new data continue to emerge.

Background and Aims Wire-guided biliary cannulation has been demonstrated to improve cannulation rates and reduce post-ERCP pancreatitis (PEP), but the impact of wire caliber has not been studied. This study compares successful cannulation rates and ERCP adverse events by using a 0.025-inch and 0.035-inch guidewire. Methods A randomized, single blinded, prospective, multicenter trial at 9 high-volume tertiary-care referral centers in the Asia-Pacific region was performed. Patients with an intact papilla and conventional anatomy who did not have malignancy in the head of the pancreas or ampulla and were undergoing ERCP were recruited. ERCP was performed by using a standardized cannulation algorithm, and patients were randomized to either a 0.025-inch or 0.035-inch guidewire. The primary outcomes of the study were successful wire-guided cannulation and the incidence of PEP. Overall successful cannulation and ERCP adverse events also were studied. Results A total of 710 patients were enrolled in the study. The primary wire-guided biliary cannulation rate was similar in 0.025-inch and 0.035-inch wire groups (80.7% vs 80.3%; P = .90). The rate of PEP between the 0.025-inch and the 0.035-inch wire groups did not differ significantly (7.8% vs 9.3%; P = .51). No differences were noted in secondary outcomes. Conclusion Similar rates of successful cannulation and PEP were demonstrated in the use of 0.025-inch and 0.035-inch guidewires. (Clinical trial registration number: NCT01408264.)

Endoscopic Variceal Ligation (EVL): The More, the Merrier? A Prospective Multicenter Randomized Controlled Study Jose D. Sollano Jr., Frederick T. Dy, Stephen N. Wong, Melchor M. Chan, Albert E. Ismael, Jose A. Tan, Evan G. Ong, Marvin D. Basco Background: Bleeding from ruptured esophageal varices is a catastrophic sequela of portal hypertension and is associated with a high mortality rate. Endoscopic variceal ligation (EVL) can completely obliterate varices and is currently the treatment of choice for acute variceal bleeding. Due to its low complication rate and ease of deployment, ligating asmany varices as possible in a single sessionmay improve outcomes and cut costs of therapy. The objective of this study is to determine the outcome of deploying more than 6 bands vs. 6 bands or less per session of EVL. Methods: All patients with evidence of active or recent bleeding from esophageal varices with no history of previous EVL, sclerotherapy or intake of beta-blockers for the past 6 months were randomized into two groups (Group 1 >6 bands; Group 2 0.05) although there was more alcoholic cirrhosis in Group 2 (Group 1=21.4% vs. Group 2=51.6%, p=0.03). Mean follow-up was 13.5 +/ 9.7 mos. for all patients. Sessions needed for complete variceal obliteration were similar (Group 1=1.6 vs. Group 2=1.9, p=0.209). There was a failure to achieve complete obliteration in 18%and 13%of patients inGroups 1 and 2, respectively. Therewas no difference in both rebleeding (42.9% vs. 25.8% overall rebleeding; mean interval to rebleeding 13.6 vs. 20 mos.; 2-year rebleeding rate 65.3% vs. 31.8%; Group 1 vs. 2, p=0.182) and survival between the 2 groups (60.7% vs. 71% overall survival; 17.4 vs. 19.7 mos. mean **602 Utility of EUS-FNA in the Evaluation of Primary Lung Mass Shyam Varadarajulu, Brenda J. Hoffman, Robert H. Hawes, Mohamad Eloubeid