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ACG 2020 ePoster Hall

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October 23 – 28, 2020 (Friday – Wednesday)

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P0770A (S0327A). CRC Screening: National Survey Insights Into Primary Care Provider Recommendations 1406312 David Johnson Eastern Virginia Medical School CRC Screening: National Survey Insights Into Primary Care Provider Recommendations Colorectal Cancer Prevention ePoster Session David A. Johnson, MD, MACG1, Kanetha Wilson, PhD2, Katie S. Lucero, MS, PhD3, Shari Dermer, PhD4, John M. Maeglin, MBA5, Doug Rex, MD, MACG6; 1Eastern Virginia Medical School, Norfolk, VA; 2Medscape, LLC, Atlanta, GA; 3Medscape Education, New York City, NY; 4Medscape Education, New York, NY; 5Medscape, LLC, Deerfield, IL; 6Indiana University Hospital, Indianapolis, INIntroduction: Provider directed advice is important for patient acceptance in CRC screening. Recent evidence has suggested that physicians’ own screening practices might affect screening in their patients.[1].Methods: Medscape conducted a U.S. based web survey to determine if primary care physicians’ (PCPs) and Ob-Gyns’ (OB-GYNs) recommendations for CRC screening aligned with CRC screening choices that they would select for themselves. Email invitations were sent to 1500 members, and the survey remained open until at least 150 physicians were recruited; no reminder emails were sent. Data were collected anonymously; the study was exempt from IRB review. All participants were recruited and responded December 2 to December 5, 2019. Descriptive statistics were examined, and chi-square tests compared provider choices for patients for screening vs. choices for themselves.Results: PCPs (n=106) and OB-GYNs (n=56) responded (survey response 11%) Mean age: 47 yrs; in practice 17 yrs. 62% group practice. 88% of physicians rated effectiveness of prevention as “very important” for why they recommend the tests they do for CRC screening (Table 1). However, when asked what their first choice for screening was, only 55% chose colonoscopy, with 33% choosing to discuss the pros and cons of all options and letting the patient decide (Table 2). Surprisingly, when this group was asked what their second choice was, only 13% said colonoscopy. When comparing self-choice vs. patient choice, there was a significant difference in the number who chose colonoscopy for themselves vs. their patients as the first choice both PCPs (x2=21.975(1), p Discussion: Despite physician high ranking for CRC prevention, only 55% picked colonoscopy- the best CRC prevention test. Significant disparity is evident for PCP selection of self testing vs patient recommendation for CRC screening. Recognition of referring provider practice should open new understanding for educational messaging towards optimizing efforts for CRC prevention. The authors recognize that this survey may represent a convenience sample. References: Litwin O, Sontrop JM, McArthur E, et al. Uptake of colorectal cancer screening by physicians is associated with greater uptake by their patients. Gastroenterology 2020;158:906-914Table 1. Table 1. Importance of the following for your typical recommendation to patients about CRC screeningTable 2. Comparison of first /second choice% recommendations by providers to patients Note: Percentages in each column may not sum to 100% because of rounding a 2nd choice includes those who selected “discuss pros and cons” as a first choice; for that group (n=44), order of choices: 46% FIT-fecal DNA test, 30% fecal immunochemical test, 16% colonoscopy, 7% guaiac based FOBT, 4% flexible sigmoidoscopy, 2% CT colonographyTable 3. Comparison of first choice recommendations for patients vs providers themselvesa[a] Note: Percentages in each column may not sum to 100% because of rounding [a] excludes those who selected “I discuss pros and cons of tests and let patient decide” as the first choice.Disclosures:David Johnson: CEGX – Consultant. CRH MEDICAL – Consultant. HYGIeaCare – Consultant. ironwood – Advisory Committee/Board Member. MEDSCAPE – Advisory Committee/Board Member.Kanetha Wilson indicated no relevant financial relationships. Katie Lucero indicated no relevant financial relationships. Shari Dermer indicated no relevant financial relationships.John Maeglin indicated no relevant financial relationships. Doug Rex: Aries Pharmaceutical – Consultant. Boston Scientific – Consultant. Braintree Laboratories – Consultant. Covidian/Medtronic – Consultant. EndoAid – Grant/Research Support. Endokey – Consultant. Erbe USA Inc – Grant/Research Support. GI Supply – Consultant. Lumendi, Ltd. – Consultant. Medivators – Grant/Research Support. Medtronic – Consultant. Norgine – Consultant. Olympus Corporation – Consultant, Grant/Research Support. Satisfai Health – Stockholder/Ownership Interest (excluding diversified mutual funds).

P0010 (S0016). Efficacy of Pancreatoscopy for Pancreatic Duct Calculi: A Systematic Review and Meta-Analysis 1387880 Harmeet Mashiana University of Nebraska Medical Center Efficacy of Pancreatoscopy for Pancreatic Duct Calculi: A Systematic Review and Meta-Analysis Biliary/Pancreas ePoster Session Harmeet S. Mashiana, MD1, Syed M. Saghir, MD2, Babu P. Mohan, MBBS, MD3, Banreet S. Dhindsa, MD2, Amaninder Dhaliwal, MD1, Saurabh Chandan, MD1, Neil Bhogal, MD1, Sarah Malik, MD1, Ishfaq Bhat, MD1, Shailender Singh, MD1, Douglas G. Adler, MD4; 1University of Nebraska Medical Center, Omaha, NE; 2University of Nevada, Las Vegas, NV; 3University of Utah, Salt Lake City, UT; 4University of Utah School of Medicine, Salt Lake City, UTIntroduction: Pancreatic duct calculi (PDC) can lead to significant abdominal pain for patients. Per oral pancreatoscopy (POP) is increasingly being used for the management of main PDC in the setting of chronic pancreatitis. POP uses 2 techniques: Electrohydraulic lithotripsy (EHL) and Laser lithotripsy (LL). Safety profile and efficacy is limited for this procedure. We performed a systematic review and meta-analysis with a primary aim to calculate the pooled technical and clinical success rates of POP. The secondary aim assessed pooled rates of technical success, clinical success for both the individual techniques, and adverse event rates.Methods: We conducted a comprehensive search of multiple electronic databases and conference proceedings (from 1999 to October 2019) to identify studies with ages greater than 17 and any gender that reported on outcomes of POP, EHL and LL. Technical success was defined as the rate of clearing PDC and clinical success as the improvement in pain. Random-effects model was used for analysis. Heterogeneity was calculated using the Cochran Q statistical test and I2 statistics. Publication bias was ascertained, qualitatively by visual inspection of funnel plot and quantitatively, by the Egger test.Results: A total of 16 studies reporting on 397 patients met the inclusion criteria. The technical success rate of POP was 76.4% (95% CI= 65.9-84.5; I2=64%) and clinical success rate was 76.8% (95% CI= 65.2-85.4; I2=66%). The technical success rate of EHL was 70.3% (95% CI= 57.8-80.3; I2=36%) and clinical success rate of EHL was 66.5% (95% CI= 55.2-76.2; I2=19%). The technical success rate of LL was 89.3% (95% CI= 70.5-96.7; I2=70%) and clinical success rate of LL was 88.2% (95 % CI= 66.4-96.6; I2=77%). The pooled POP adverse events rate was 14.9% (95% CI= 9.2-23.2; I2=49%). The pooled adverse events rate for EHL was 11.2% (95% CI= 5.9-20.3; I2=15%) and for LL was 13.1% (95% CI=6.3-25.4; I2=31%). Subgroup analysis of adverse events showed rates of post ERCP pancreatitis (PEP) at 7% (95% CI= 3.5-13.6; I2= 38%), fever at 3.7% (95%CI= 2-6.9; I2=0), abdominal pain at 4.7% (95% CI= 2.7-7.8; I2=0), perforation at 4.3% (95% CI= 2.1-8.4; I2=0), hemorrhage at 3.4% (95% CI= 1.7-6.6; I2=0) and no mortality. There was evidence of publication bias based on funnel plot analysis and Egger’s test.Discussion: Our study highlights the high technical and clinical success rates for POP, EHL and LL. POP guided lithotripsy could be a viable option for management of chronic pancreatitis with PDC.Forest plot for the technical success of POPForest plot for the clinical success of POPPooled rates of technical success, clinical success, and AE of POP, EHL and LLDisclosures:Harmeet Mashiana indicated no relevant financial relationships. Syed Saghir indicated no relevant financial relationships. Babu Mohan indicated no relevant financial relationships. Banreet Dhindsa indicated no relevant financial relationships. Amaninder Dhaliwal indicated no relevant financial relationships. Saurabh Chandan indicated no relevant financial relationships. Neil Bhogal indicated no relevant financial relationships. Sarah Malik indicated no relevant financial relationships. Ishfaq Bhat indicated no relevant financial relationships. Shailender Singh indicated no relevant financial relationships. Douglas Adler indicated no relevant financial relationships.

P0020 (S0026). Predictors for Improvement of Chronic Pancreatitis Symptoms After Single Operator Pancreatoscopy With Intraductal Lithotripsy or Extracorporeal Shock Wave Lithotripsy for Large Main Pancreatic Duct Stones 1390217 Benjamin Bick Indiana University School of Medicine Predictors for Improvement of Chronic Pancreatitis Symptoms After Single Operator Pancreatoscopy With Intraductal Lithotripsy or Extracorporeal Shock Wave Lithotripsy for Large Main Pancreatic Duct Stones Biliary/Pancreas ePoster Session Award: Category Award (Biliary/Pancreas)Award: Presidential Poster AwardBenjamin L. Bick, MD, Feenalie Patel, MD, Jeffrey J. Easler, MD, James Watkins, MD, Mark A. Gromski, MD, Evan L. Fogel, MD, Glen A. Lehman, MD, Stuart Sherman, MD; Indiana University School of Medicine, Indianapolis, INIntroduction: Main pancreatic ductal stones (MPDS) complicate chronic pancreatitis (CP), leading to disabling symptoms such as intractable pain and exocrine pancreatic insufficiency (EPI). Large MPDS (≥5 mm) are more difficult to extract and require lithotripsy with either single operator pancreatoscopy with intraductal lithotripsy (SOPIL) or extracorporeal shock wave lithotripsy (ESWL). This study aims to identify clinical predictors for improvement of CP symptoms after MPDS lithotripsy.Methods: We retrospectively identified CP patients from 9/2013 to 9/2019 who underwent SOPIL or ESWL for MPDS therapy at our center. Electrohydraulic lithotripsy (EHL) was used for SOPIL. Successful stone clearance was defined as >80% stone fragmentation and extraction. Clinical outcomes: patient reported pain improvement at follow-up, improvement of EPI defined by cessation of enzyme supplementation. Possible predictors identified in univariate logistic regression models (p-value < 0.25) were subsequently used in multivariable logistic regression models, with significance defined as p-value < 0.05.Results: Of the 217 MPDS patients managed with lithotripsy, technical success occurred in 189/217 (87.1%). Pain improvement occurred in 168/197 (85.3%). Exocrine insufficiency was present in 109 and pancreas enzyme supplementation was able to be discontinued in 8 (7.3%) after stone clearance. Analysis for predictors of pain improvement (Table 1) identified concurrent exocrine insufficiency, alcohol etiology, idiopathic etiology, and technically successful stone clearance as possible predictors. On multivariable analysis, technical success was highly predictive of pain improvement (OR 196.57 [41.322-935.10], p< 0.001). Analysis for predictors of EPI improvement identified multiple possible predictors (Table 2). On multivariable analysis, a SOPIL approach (OR 43.565 [3.146-603.34, p=0.005) predicted EPI improvement and upstream PD diameter increase by every 1 mm was a negative predictor for EPI improvement (OR 0.512 [0.284-0.925], p=0.026).Discussion: Technical success of lithotripsy for MPDS predicted improvement of baseline abdominal pain in CP independent of other clinical factors. A SOPIL over ESWL approach independently predicted improvement of EPI symptoms. Upstream main pancreatic duct diameter as a possible surrogate marker for duration of obstruction and organ atrophy is a negative predictor for resolution of EPI symptoms after lithotripsy approaches for MPDS.Table 1. Univariate and multivariable logistic regression model assessing predictors of pain improvement in patients who underwent single operator pancreatoscopy with intraductal lithotripsy (SOPIL) or extracorporeal shock wave lithotripsy (ESWL)Table 2. Univariate and multivariable logistic regression model assessing predictors of exocrine pancreatic insufficiency improvement (defined by cessation of pancreatic enzymes supplementation) in patients who underwent single operator pancreatoscopy with intraductal lithotripsy (SOPIL) or extracorporeal shock wave lithotripsy (ESWL)Disclosures:Benjamin Bick indicated no relevant financial relationships. Feenalie Patel indicated no relevant financial relationships. Jeffrey Easler: Boston Scientific – Consultant.James Watkins indicated no relevant financial relationships. Mark Gromski: Boston Scientific – Consultant.Evan Fogel indicated no relevant financial relationships. Glen Lehman: Cook Medical – Consultant.Stuart Sherman: Boston Scientific – Consultant. Cook Medical – Consultant. Olympus – Consultant.

P0030 (S0036). Examining Healthcare Utilization Trends for Acute Pancreatitis in a Large Health System 1389461 Cory Higley MedStar Georgetown University Hospital Examining Healthcare Utilization Trends for Acute Pancreatitis in a Large Health System Biliary/Pancreas ePoster Session Cory Higley, DO, MPH1, Albert C. Shu, MD1, Wei Yan, MD1, Rabin Neupane, MBBS2, Disha Sharma, MBBS2, Bryan S. Stone, DO1, Andrew Stevens, MD1, Shandiz Shahbazi, MD1, Ilan Vavilin, MD1, Nadim G. Haddad, MD3, Sandeep Nadella, MBBS1; 1MedStar Georgetown University Hospital, Washington, DC; 2MedStar Washington Hospital Center, Washington, DC; 3MedStar Georgetown University Hospital, Potomac, MDIntroduction: Acute pancreatitis (AP) is the third most common cause of gastrointestinal (GI)-related hospitalizations in the US and the fourth leading GI illness associated with all-cause 30-day readmissions. Readmissions are associated with increased healthcare utilization as well as mortality from AP at one year. To minimize risk for readmissions, guidelines recommend smoking/alcohol cessation counseling and same-admission cholecystectomy for alcoholic and gallstone AP, respectively. We examined healthcare utilization trends for AP using encounters as a proxy within a large health system.Methods: ICD-10 codes for AP were used to identify patients who presented to emergency departments (ED) within the MedStar Health system between March 2015 and June 2019. 4,043 patient encounters were eligible for retrospective chart review; these included ED visits and inpatient admissions. Manual review yielded 2,542 charts with extractable clinical information, 1,903 of which had AP as defined by Revised Atlanta Classification (RAC). Variables such as demographics, ever-history of AP, and recent AP within the past 30 days requiring an ED visit were collected. Statistical analysis was performed using GraphPad PRISM.Results: Of 1,903 patients who satisfied RAC for AP, 184 (9.67%) had represented within 30 days following discharge from index presentation. Of those who returned, 22.3% had gallstone pancreatitis and 27.7% had alcoholic pancreatitis as their diagnosis on index hospitalization. 39.7% of those with gallstone pancreatitis had a same-admission cholecystectomy. Those with ever-history of AP were more likely to return following discharge (OR 1.51, p = 0.0136); this effect was more pronounced in patients who had presented immediately prior to index encounter (OR 3.62, p < 0.001). Those who had a previous encounter within the past 30 days had a statistically significant longer length of stay. There was no statistically significant difference in need for ICU level of care between those who were admitted within past 30 days and those who were not.Discussion: Patients with prior encounters for AP are at increased risk for returning to an acute care site and thus increased healthcare utilization. These re-encounters tend to be associated with longer length of stays. Following guidelines and identifying subpopulations most at risk for readmissions would allow for targeted interventions to decrease healthcare utilization.Disclosures:Cory Higley indicated no relevant financial relationships. Albert Shu indicated no relevant financial relationships. Wei Yan indicated no relevant financial relationships. Rabin Neupane indicated no relevant financial relationships. Disha Sharma indicated no relevant financial relationships. Bryan Stone indicated no relevant financial relationships. Andrew Stevens indicated no relevant financial relationships. Shandiz Shahbazi indicated no relevant financial relationships. Ilan Vavilin indicated no relevant financial relationships. Nadim Haddad indicated no relevant financial relationships. Sandeep Nadella indicated no relevant financial relationships.

P0050 (S0056). A Nationwide Analysis of Outcomes in a Depressed Patient With Pancreatitis 1390798 Fahad Chaudhary West Virginia University, School of Medicine A Nationwide Analysis of Outcomes in a Depressed Patient With Pancreatitis Biliary/Pancreas ePoster Session Fahad Chaudhary, MD, Ridwaan Albeiruti, MD; West Virginia University, School of Medicine, Morgantown, WVIntroduction: : Depression affects nearly 1 in 12 Americans and expected to increase over the next decade. Depression may have an adverse effect on clinical outcomes in patients with pancreatitis. In an effort to maintain the improvement of acute pancreatitis, we sough to evaluate the impact of depression on patients with pancreatitis using national inpatient data.Methods: The Nationwide Inpatient Sample (2003-2016) was used to identify all adult patients requiring inpatient hospitalization with a primary diagnosis of acute and chronic pancreatitis. Primary outcomes studied included morality, acute renal failure, acute respiratory failure, septic shock as well as secondary outcomes such as length of stay and hospital cost were analyzed using univariate and multivariate regressions.Results: From 2003-2016, the nation estimate for patients hospitalized with acute and chronic pancreatitis was 7,158,894. Of these, 508,282 (7.1%) patients carried a diagnosis of depression as well. Patients hospitalized for pancreatitis with depression were more likely to be under the age of 65 (87% vs 73%%, p< 0.001), female (52% vs 49%%, p< 0.001) and White (71% vs 64%, p< 0.001). The etiology of their pancreatitis was more likely to be Alcohol use (35% vs 23%, p< 0.001) than biliary and other causes. Depressed patients had a lower likelihood of mortality (1.2% vs 2.3%, p< 0.001) and needing endoscopic intervention (7.4% vs 9.9%, p< 0.001) during the hospitalization but were more likely to leave against medical advice (3.5% vs 2.0%, p< 0.001), have GI bleeding (3.6% vs 3.0%, p< 0.001), respiratory failure (5.2% vs 4.8%, p< 0.001) and AKI (12.1% vs 11.8%, p< 0.001). There were no differences in patient with and without depression when it came to outcomes such as septic shock, length of stay or total cost of hospitalization.Discussion: Patients with depression seem to have a lower likelihood of mortality and need for endoscopy intervention but are more likely to incur morbidities such as AKI, respiratory failure and GI bleeding while also being more prone to leave against medical advice. Further, randomized control trials are needed to elucidate the exact cause of these findings. Disclosures:Fahad Chaudhary indicated no relevant financial relationships. Ridwaan Albeiruti indicated no relevant financial relationships.

P0060 (S0066). Trends and Socioeconomic Health Outcomes of Cannabis Use Among Patients With Chronic Pancreatitis 1388879 Thomas McCarty Brigham & Women's Hospital Trends and Socioeconomic Health Outcomes of Cannabis Use Among Patients With Chronic Pancreatitis Biliary/Pancreas ePoster Session Thomas R. McCarty, MD1, Fouad Chouairi, BS2, Prabin Sharma, MD3, Kelly E. Hathorn, MD1, Thiruvengadam Muniraj, MD, PhD2, Christopher C. Thompson, MD, MSc1; 1Brigham & Women's Hospital, Boston, MA; 2Yale University, School of Medicine, New Haven, CT; 3Bridgeport Hospital, Yale University School of Medicine, Bridgeport, CTIntroduction: Chronic Pancreatitis (CP) may result in persistent, debilitating abdominal pain and pancreatic insufficiency. Recent literature suggests cannabis may be an effective adjunctive therapy for the treatment of pain associated with CP; however, there remains a paucity of epidemiologic data. As such, along with the increase in legalization of cannabis across the United States, we aimed to investigate the impact of cannabis use on relevant clinical outcomes among hospitalized patients with CP.Methods: Patients with a diagnosis of CP were reviewed from the Nationwide Inpatient Sample (NIS) database between 2008 and 2014. CP was identified by International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes with patients classified with or without a co-diagnosis of cannabis use disorder. Measured variables including age, race/ethnicity, comorbidities, hospital type, hospital region, insurance payer type, median household income quartile, length of hospital stay, total cost, and mortality were compared between cohorts using chi-squared and ANOVA. Annual trends over the study period were also evaluated.Results: A total of 215,520 patients with CP were analyzed (n=5,947 patients with concomitant cannabis use disorder). Baseline patient and hospital characteristics are highlighted in Table 1. Patients with cannabis use disorder and CP were more likely to be younger and male gender compared to non-users [(43.4±10.8 vs 51.8±15.3 years;P< 0.001) and (70.5% vs 54.2%;P< 0.001), respectively]. Cannabis use was also associated with a lower median household income as well as Medicaid payor status (all P< 0.001). Despite differences in comorbidities, length of stay (4.3±4.1 vs 5.8±6.9 days;P< 0.001), hospital costs ($27082±24361 vs $39044±62372;P< 0.001), and mortality (0.3% vs 1.5%;P< 0.001) were decreased for patients with CP and cannabis use compared to non-users. Furthermore, the incidence of cannabis use among patients with CP significantly increased over the study period from 9.3% in 2008 to 17.9% in 2014 – average increase of 1.43% per year (Ptrend< 0.001).Discussion: Based on this nationwide analysis, cannabis use among patients with CP has increased over time and was associated with a reduction in hospital length of stay, lower hospitalization costs, and decreased mortality. Future studies to examine the nature of this relationship are needed.Table 1: Baseline Patient and Hospital Characteristics of Patients with Chronic Pancreatitis: Patients With and Without Cannabis Use DisorderTable 2: Annual Trends of Cannabis Use and Chronic Pancreatitis Over Study PeriodDisclosures:Thomas McCarty indicated no relevant financial relationships. Fouad Chouairi indicated no relevant financial relationships. Prabin Sharma indicated no relevant financial relationships. Kelly Hathorn indicated no relevant financial relationships. Thiruvengadam Muniraj indicated no relevant financial relationships. Christopher Thompson: Apollo Endosurgery – Consultant, Grant/Research Support. Aspire Bariatrics – Grant/Research Support. BlueFlame Healthcare Venture Fund – Other Financial or Material Support, General Partner. Boston Scientific – Consultant. Covidien/Medtronic – Consultant. EnVision Endoscopy – Other Financial or Material Support, Board Member. Fractyl – Consultant, Other Financial or Material Support, Advisory Board Member. GI Dynamics – Consultant, Grant/Research Support. GI Windows – Stockholder/Ownership Interest (excluding diversified mutual funds). Olympus/Spiration – Consultant, Grant/Research Support. Spatz – Grant/Research Support. USGI Medical – Consultant, Grant/Research Support, Other Financial or Material Support, Advisory Board Member.

P0070 (S0076). Patients With Alcohol Use and Acute Pancreatitis Are Less Likely to Undergo Etiology Workup for Acute Pancreatitis: A Retrospective Analysis 1389857 Rabin Neupane MedStar Washington Hospital Center Patients With Alcohol Use and Acute Pancreatitis Are Less Likely to Undergo Etiology Workup for Acute Pancreatitis: A Retrospective Analysis Biliary/Pancreas ePoster Session Rabin Neupane, MBBS1, Disha Sharma, MBBS1, Andrew Stevens, MD2, Bryan S. Stone, DO2, Wei Yan, MD2, Shandiz Shahbazi, MD2, Ilan Vavilin, MD2, Cory Higley, DO, MPH2, Albert C. Shu, MD2, Sandeep Nadella, MBBS2, Nadim G. Haddad, MD3; 1MedStar Washington Hospital Center, Washington, DC; 2MedStar Georgetown University Hospital, Washington, DC; 3MedStar Georgetown University Hospital, Potomac, MDIntroduction: Acute pancreatitis (AP) is a common gastrointestinal tract pathology which accounts for significant patient and financial burden. Alcohol and biliary causes including gallstones are the two most common causes of AP. In our large health system comprising of 9 hospitals, we determined the trends of patients presenting with Alcohol associated Acute Pancreatitis (AAP). Specifically, we characterized trends in diagnosis and adherence to treatment guidelines within our health system to ascertain gaps in performance. Methods: After obtaining IRB approval, we used ICD-10 codes to retrieve charts of patients admitted presenting to emergency departments within the MedStar Health System between March 2015- June 2019. 4,043 patient encounters were eligible for retrospective chart review, of which 2,542 charts with complete clinical information were manually reviewed. Variables pertaining to alcohol related AP was extracted including the demographics, symptoms, etiology work up, lipase levels, imaging, length of stay, complications of AP, and need for intensive care. Revised Atlanta classification was used to define the diagnosis of AP. Statistical analysis were performed including T-test, ANOVA using GraphPad PRISM for Mac OS (Version 8). Results: 1,903 patients out of 2,542 met revised Atlanta classification for AP despite all of them had the ICD-10 code for AP. AAP was the most common etiology noted in our cohort with 738 cases (29.0%). 83.3% (615) of AAP patients met criteria for AP. AAP patients were less likely to have an etiology workup done compared to not alcohol associated AP (p=0.0002, Odds Ratio (0.71, 95%CI of 0.59-0.85). If there was active alcohol use documented, these patients were less likely to have a documented work up for AP, p=0.002(OR 0.73, 95%CI 0.62-0.86). The billing diagnosis for AAP had a sensitivity of 95% and specificity of 97%. Clinical criteria (pain) had a sensitivity of 97% and specificity of 12% respectively. Discussion: AAP is a major cause of AP within our cohort. The billing diagnosis frequently corroborates to the documented etiology when alcohol is involved. However, a significant portion of AP patients do not have a documented workup when alcohol use is noted in history, which may explain the inaccurate diagnosis. These represent avenues for targeted interventions to improve the adherence to AP guidelines across a large health management organization.Graph showing the trend of diagnosis work up in ETOH associated and non ETOH associated acute pancreatitisGraph showing the trend of diagnosis workup among patient who had active alcohol use and patient without active alcohol use.Disclosures:Rabin Neupane indicated no relevant financial relationships. Disha Sharma indicated no relevant financial relationships. Andrew Stevens indicated no relevant financial relationships. Bryan Stone indicated no relevant financial relationships. Wei Yan indicated no relevant financial relationships. Shandiz Shahbazi indicated no relevant financial relationships. Ilan Vavilin indicated no relevant financial relationships. Cory Higley indicated no relevant financial relationships. Albert Shu indicated no relevant financial relationships. Sandeep Nadella indicated no relevant financial relationships. Nadim Haddad indicated no relevant financial relationships.

P0080 (S0086). Impact of Image Quality on Single-Operator Pancreatoscopy-Guided Intraductal Lithotripsy for the Treatment of Main Pancreatic Duct Stones 1390287 Feenalie Patel Indiana University Impact of Image Quality on Single-Operator Pancreatoscopy-Guided Intraductal Lithotripsy for the Treatment of Main Pancreatic Duct Stones Biliary/Pancreas ePoster Session Feenalie Patel, MD1, Jeffrey J. Easler, MD2, Stuart Sherman, MD2, Evan L. Fogel, MD2, Mark A. Gromski, MD2, James Watkins, MD2, Glen A. Lehman, MD2, Benjamin L. Bick, MD2; 1Indiana University, Indianapolis, IN; 2Indiana University School of Medicine, Indianapolis, INIntroduction: For large pancreatic duct (PD) stones (≥5 mm), ERCP with single operator pancreatoscopy (SOP) guided electrohydraulic lithotripsy (EHL) is an emerging technique. The SOP systems have been refined with interval advances in image quality, evolving from a fiberoptic (f-SOP) to a digital (d-SOP) platform. The aim of this study is to report our center’s experience in terms of effectiveness and safety of SOP-EHL for the management of MPDS and assess for technical benefits from interval advances in image quality.Methods: This is a retrospective series of patients who underwent SOP-EHL for the treatment of large MPDS from 9/2013 to 9/2019. Technical success was defined as complete or near complete stone clearance based on final pancreatogram. Clinical success was defined by improvement in pain or exocrine insufficiency (EPI) (cessation of enzyme supplementation after EHL).Results: 18 patients underwent SOP-EHL including 8 with the f-SOP platform and 10 with the d-SOP platform. Baseline characteristics (Table 1) are similar between platforms. Symptoms prompting MPDS therapy included chronic pain (94.4%) and recurrent acute pancreatitis (5.6%). Number of large MPDS ranged from 1-4. Stone size ranged from 5-33 mm. Patients managed with the d-SOP platform were more likely to have a prior failed attempt at stone extraction (60% vs 12.5%, p=0.040). Intraprocedural therapies and outcomes are included in table 2. Overall technical success was seen in 89%. Patients treated with d-SOP trended towards a higher rate of technical success (100% vs 75%, p=0.094), fewer total shocks (1633±1708 vs 5997±6356, p=0.057) and shorter procedure duration (80.2±35.8 vs 132.0±87.8 minutes, p=0.107). Both technical failures with f-SOP went on to successful lithotripsy with ESWL. Exocrine insufficiency clinically resolved in 38.5%. Patients that experienced technical success had on average fewer lithotripsy sessions (1.3±0.5 vs 3.5±2.1, p< 0.001), fewer shocks (1909±1592 vs 15498, p< 0.001), and a lower total procedure duration (85.8±30.8 vs 243±138.6, p< 0.001). On univariate analysis, no baseline characteristics were associated with technical failure.Discussion: SOP-EHL is safe and effective for clearance of MPDS and impactful for CP symptoms. The d-SOP compared to f-SOP platform is associated with fewer total shocks and lower procedure time, likely due to improved optics. Our data suggests that improved imaging of MPDS with d-SOP enhances procedure efficiency and may equate to an increased rate of technical success.Table 1. Baseline characteristics of patients with large main pancreatic ductal stones who underwent single operator pancreatoscopy (SOP) with electrohydraulic lithotripsyTable 2. Outcomes in patients with large main pancreatic ductal stones who underwent single operator pancreatoscopy (SOP) with electrohydraulic lithotripsyFigure 1: (A) Second generation digital single-operator pancreatoscopy (d-SOP) view of the main pancreatic duct stone, followed by (B) Electrohydraulic Lithotripsy (EHL) with stone fragmentation.Disclosures:Feenalie Patel indicated no relevant financial relationships. Jeffrey Easler: Boston Scientific Co. – Consultant.Stuart Sherman: Boston Scientific – Consultant.Evan Fogel indicated no relevant financial relationships. Mark Gromski: Boston Scientific – Consultant.James Watkins indicated no relevant financial relationships. Glen Lehman: Cook Medical – Consultant.Benjamin Bick indicated no relevant financial relationships.

P0090 (S0096). Differences in Genomic Mutations in Precancerous Pancreatic Cysts Between African Americans and Caucasians 1390017 Michael Rowley University of Texas Southwestern Medical Center Differences in Genomic Mutations in Precancerous Pancreatic Cysts Between African Americans and Caucasians Biliary/Pancreas ePoster Session Michael Rowley, MD, Hendrikus Vanderveldt, MD, MBA; University of Texas Southwestern Medical Center, Dallas, TXIntroduction: Intraductal papillary mucinous neoplasms (IPMNs) are one of the recognized precursors of pancreatic ductal adenocarcinoma (PDAC). Detection of precancerous and early stage neoplastic lesions is critical given the poor 5-year survival rates of PDAC. Although malignant transformation occurs in the minority of lesions, those that do transform are more likely to have high-risk genomic mutations. Next generation sequencing (NGS) identifies IPMNs with these high-risk mutations.African Americans have a higher incidence of PDAC than Caucasians. Multiple factors have been identified that partly explain this difference. However, genomic variability in IMPNs between races has not been studied. Aim: Evaluate differences in high-risk genomic mutations in IPMNs between African Americans and Caucasians.Methods: Single institution retrospective cohort study identifying 94 consecutive patients in 2019 who underwent 100 EUS with FNA or ERCP with fluid sampling of pancreatic cysts or pancreatic duct dilation. Indication for diagnostic sampling was based on standard high-risk criteria by ACG guidelines. All cyst fluid was sent for NGS with PancreaSeq®. Presence of GNAS and/or KRAS mutation confirmed diagnosis of IPMN. High-risk genomic mutations were TP53, PIK3CA, AKT1, PTEN and SMAD4. Clinical demographics and cyst variables were collected: age, gender, race, BMI, history of pancreatitis, diabetes, smoking, family history of PDCA, cyst size, nodules, duct dilation, CEA level and genomic profile. Differences between African Americans and Caucasians compared with univariate analysis; p < 0.05 significant. Logistic regression for presence of high-risk mutations performed; p < 0.05 significant.Results: 53 samples were positive for a GNAS and/or KRAS mutation in 49 patients. Seven of 53 samples (12%) had a high-risk mutation. On univariate analysis, clinical and cyst variables did not differ by race. The rate of high-risk mutations did not differ: 29% in African Americans vs 11% in Caucasians (p = 0.197). However, there was a trend toward increased rate of high-risk mutations in African Americans on logistic regression when controlling for other collected variables (p = 0.071). No other variables were independently predictive of high-risk mutations.Discussion: Higher rates of high-risk genomic mutations in IPMNs might be a factor in explaining the higher rates of PDAC in African Americans. Larger studies are needed to evaluate these findings.Disclosures:Michael Rowley indicated no relevant financial relationships. Hendrikus Vanderveldt indicated no relevant financial relationships.

P0100 (S0106). Imaging Resource Utilization in the Surveillance of Presumed Branched Duct Intraductal Papillary Mucinous Neoplasm (BD-IPMN) 1388354 Muhammad Yousaf MedStar Union Memorial Hospital Imaging Resource Utilization in the Surveillance of Presumed Branched Duct Intraductal Papillary Mucinous Neoplasm (BD-IPMN) Biliary/Pancreas ePoster Session Muhammad N. Yousaf, MD1, Zhiyuan Zhang2, Ankit Chhoda, MD3, Kamraan Madhani, MD3, Fizah Chaudhary, MD1, Alejandro Suarez, MD3, Thiruvengadam Muniraj, MD, PhD3, John W. Kunstman, MD, MHS3, Priya Jamidar, MD3, Harry Aslanian, MD3, Ronald Salem, MD3, James J. Farrell, MD3; 1MedStar Union Memorial Hospital, Towson, MD; 2Yale University, New Haven, CT; 3Yale University, School of Medicine, New Haven, CTIntroduction: Presumed mucinous cystic lesions are at increased (albeit low) risk of malignant transformation and require regular imaging for ongoing surveillance. A cost-effective evaluation of imaging resource utilization (IRU) is understudied due to a paucity of actual clinical utilization data and lack of consensus among current guidelines. We assessed the value proposition of IRU in surveillance of BD-IPMN, by defining populations utilizing high volumes of imaging, and identifying the predictors of high IRU.Methods: This is a single-center cross-sectional study, of patients with presumed BD-IPMN under active surveillance as of January 2018. Patients were identified from a prospectively maintained pancreatic cyst neoplasm (PCN) database. Presumed diagnosis of mucinous cysts with identification of worrisome features (WF) and high-risk stigmata (HRS), was made based on the accepted criteria from the literature. IRU was calculated based on both noninvasive (CT/MRI) and minimally invasive (EUS) imaging used per month during surveillance. For analysis, the “High Resource Utilization” (HRU) group is defined as the top 10% of the population consuming higher imaging resources and compared them with rest of the surveillance population: “Low Resource Utilization” (LRU) group. The clinical variables were compared using chi-square analysis and student’s t test between two groups.Results: 409 patients with presumed BD-IPMNs were followed for 41.60±32.24 months. By definition, the rate of surveillance imaging utilization per month in HRU group was higher, 0.74±0.42 vs 0.16±0.09 (p< 0.001). Similarly, the rate of non-invasive imaging and EUS utilization was also higher in HRU group. The HRU group have a higher initial cyst size (18.33±14.31mm vs. 12.90±9.08mm) (p< 0.001), higher proportion of cysts with WF (17.5% vs 13.82%) (p< 0.001), or with HRS (7.5% vs 1.36%) (p< 0.001), compared with LRU group. Cyst growth rate per year (30.00% vs 4.88% (p< 0.001)) and per two years (35.00% vs 13.82% (p< 0.001)) displayed higher proportions of fast-growing cysts ( >5mm threshold) in the HRU group compared with LRU group.Discussion: Higher IRU was found in a subset of presumed BD-IPMN population undergoing active surveillance using actual prospective clinical data. Predictors of this included larger initial cyst size, rapid cyst growth rate over one and two years, and the presence of WF and HRS. Further refinement of imaging guidelines is needed for accurate long term PCN surveillance balanced by cost-effective IRU.Disclosures:Muhammad Yousaf indicated no relevant financial relationships. Zhiyuan Zhang indicated no relevant financial relationships. Ankit Chhoda indicated no relevant financial relationships. Kamraan Madhani indicated no relevant financial relationships. Fizah Chaudhary indicated no relevant financial relationships. Alejandro Suarez indicated no relevant financial relationships. Thiruvengadam Muniraj indicated no relevant financial relationships. John Kunstman indicated no relevant financial relationships. Priya Jamidar indicated no relevant financial relationships. Harry Aslanian: Boston Scientific – Consultant. GI Supply – Speaker's Bureau. Olympus – Consultant.Ronald Salem indicated no relevant financial relationships. James Farrell indicated no relevant financial relationships.

P0110 (S0116). Balancing Risks of Pancreatic Malignancy-Related and Non-Pancreatic-Related Mortality in Surveillance of Low-Risk Presumed Mucinous Pancreatic Cysts 1390123 Ankit Chhoda Bridgeport Hospital, Yale University School of Medicine Balancing Risks of Pancreatic Malignancy-Related and Non-Pancreatic-Related Mortality in Surveillance of Low-Risk Presumed Mucinous Pancreatic Cysts Biliary/Pancreas ePoster Session Award: Presidential Poster AwardAnkit Chhoda, MD1, Kamraan Madhani, MD2, Muhammad N. Yousuf, MD3, Harry Aslanian, MD4, Priya Jamidar, MD4, John W. Kunstman, MD, MHS4, Ronald Salem, MD4, Alejandro Suarez, MD4, James J. Farrell, MD4; 1Bridgeport Hospital, Yale University School of Medicine, Bridgeport, CT; 2Yale University, School of Medicine, Waterbury, CT; 3MedStar Union Memorial Hospital, Baltimore, MD; 4Yale University, School of Medicine, New Haven, CTIntroduction: Charlson Comorbidity Index (CACI) has been suggested as a tool to determine comorbidity burden and guide surveillance for patients with presumed mucinous pancreatic cysts (Intrapapillary Mucinous Neoplasms and Mucinous Cystic Neoplasms). This study seeks to define the comorbidity burden among patients with low-risk pancreatic cysts i.e. cysts without worrisome features (WF) and high risk stigmata (HRS) undergoing surveillance, and provide real-world follow-up (including mortality) on this cohort.Methods: A single center prospective study including individuals with presumed mucinous pancreatic cysts undergoing active surveillance during 2016 was performed. Electronic medical records were reviewed to identify low-risk cysts without WF and HRS, and the CACI for eachindividual was calculated. After 3 years, we performed an interim analysis among these low-risk cysts to determine the disease specific (pancreatic malignancy-related, DSM), extra-pancreatic(EPM), and overall mortality (OM) using Kaplan-Meir model. Ratio of DSM/EPM was calculated for the entire low risk cyst cohort, for different CACI thresholds.Results: The surveillance population of 502 patients included 440 individuals with low-risk cysts, 50 with WF, and 12 with HRS. Among low risk cysts, only one individual (0.23%) had DSM due to metachronous pancreatic malignancy while 36(8.18%) individuals had EPM over 3 years. Baseline CACI predicted actual mortality at 3 years. Both the CACI cut-offs of 7 and 4 demonstrated significantly higher EPM among groups with “High CACI” vs “Low CACI” groups (log-tank test: p< 0.0001) (Figure 1A & 1B). Upon exclusion of individuals with CACI≥7(N=378) and CACI≥4(N=221), DSM was observed in 1 patient each (0.26% & 0.45%) but the EPM was 14(3.17%) and 1(0.45%) respectively. The ratio of DSM/EPM for CACI< 4, CACI< 7, and the entire cohort was 100%, 7.14%, and 2.78% respectively (Figure 2). Discussion: Our interim analysis demonstrates no drastic alteration in DSM but reduction in EPM as we excluded individuals from surveillance cohorts based on their CACI. Though the EPM is inevitable, due to lack of survival benefit, surveillance cessation at CACI≥ 7 and 4 would prevent unnecessary procedures, anxiety and health resource allocation among 62 and 219 individuals respectively. Our study supports incorporation of CACI in shared decisions for surveillance cessation among high CACI individuals with low risk cysts.Figure 1: Kaplan Meier Survival curves for EPM among “High CACI” vs “Low CACI” low-risk cysts with 1A: CACI cut-off of 7(χ2 =91.4, pFigure 2: Distribution of EPM, DSM and the ratios among entire cohort(N=440), Cohort with CACIDisclosures:Ankit Chhoda indicated no relevant financial relationships. Kamraan Madhani indicated no relevant financial relationships. Muhammad Yousuf indicated no relevant financial relationships. Harry Aslanian indicated no relevant financial relationships. Priya Jamidar indicated no relevant financial relationships. John Kunstman indicated no relevant financial relationships. Ronald Salem indicated no relevant financial relationships. Alejandro Suarez indicated no relevant financial relationships. James Farrell indicated no relevant financial relationships.

P0120 (S0126). An International Study of Interobserver Variability of “String Sign” of Pancreatic Cysts Among Experienced Endosonographers 1387956 Seifeldin Hakim University of Texas Health Science Center An International Study of Interobserver Variability of “String Sign” of Pancreatic Cysts Among Experienced Endosonographers Biliary/Pancreas ePoster Session Seifeldin Hakim, MD1, Emmanuel Coronel, MD2, Philip S. Ge, MD2, Suresh Chari, MD2, Nirav Thosani, MD, MHA1, Srinivas Ramireddy, MD1, Ricardo Badillo, MD1, Tomas DaVee, MD1, Marc Catalano, MD1, Robert J. Sealock, MD3, Sreeram Parupudi, MD4, Lyndon V. Hernandez, MD, MPH5, Virendra Joshi, MD6, Atsushi Irisawa, MD, PhD7, Surinder Rana, MD, DM8, Sundeep Lakhtakia, MD, DM9, Peter Vilmann, MD10, Adrian Saftiou, MD11, Siyu Sun, MD12, Marc Giovannini, MD13, Matthew Katz, MD2, Michael Kim, MD2, Graciela Nogueras-Gonzalez, MPH2, Manoop Bhutani, MD2; 1University of Texas Health Science Center, Houston, TX; 2University of Texas MD Anderson Cancer Center, Houston, TX; 3Baylor College of Medicine, Houston, TX; 4University of Texas Medical Branch, Galveston, TX; 5GI Associates, LLC, Franklin, WI; 6University Medical Center New Orleans, New Orleans, LA; 7Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan; 8Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India; 9Asian Institute of Gastroenterology, AIG Hospitals, Hyderabad, Telangana, India; 10Copenhagen University Hospital Herlev, Herlev, Hovedstaden, Denmark; 11The University of Medicine and Pharmacy of Craiova, Craiova, Grad Zagreb, Croatia; 12Shenjing Hospital of China Medical University, Shenyang, Zhejiang, China; 13University Hospital of Marseille, Marseille, Pays de la Loire, FranceIntroduction: Determining pancreatic cyst subtype can be challenging due to absence of a single optimal test. “String sign” is a simple no-cost test that can differentiate mucinous from non-mucinous cysts. It involves placing sample of the aspirated fluid from the pancreatic cysts between thumb and index finger and separate them to measure the distance between two fingers before the sample string breaks (Figure 1. However, this test has not been validated among experienced endosonographers (EE) and interpretation can be subjective. The aim of this study was to evaluate agreement among EEs when using the string sign to describe a positive test.Methods: A senior endosonographer performed EUS-FNA of pancreatic cysts and he recorded 8 videos while he is assessing the string sign test from different patients. Videos were shared with 14 EEs internationally through web-based storage-cloud. A survey was sent to the 14 EEs with 3 questions and the answers were collected. The questions were “Is the string sign positive?”, “If the string sign is positive, what is the length of the formed string?” and “What is the cutoff length for string sign to be considered positive?”Results: 112 observations were noted with 112 responses. Fourteen EEs watched 8 videos. The kappa-statistic was 0.6 among observers only which indicates a good interrater agreement regarding the positivity of the string sign (p< 0.001). Kappa-statistic was 0.38 when observers were compared against index endosonographer (IE) (p< 0.001), which denotes marginal agreement as shown in Table one. 89.8% of reviewer observations of the measured length of the formed string in positive string sign showed > 5mm variability (p< 0.001), and similar results were obtained when the observers were compared against IE measurements which indicates poor agreement (Table 2). The IE considered 5mm as a cutoff length for a formed string to be a positive test, while some authors considered 3.5mm and others considered 10mm.Discussion: String sign test of pancreatic cysts has good interrater agreement that can help in differentiating mucinous from non-mucinous cysts. It should be combined with other pancreatic cyst fluid studies and cytopathology to enhance the overall diagnostic accuracy of the combined tests. However, agreement is poor on the measured length of the formed string and the cutoff. Thus, more studies are required to determine the optimal cutoff length of a formed string to be considered a positive string sign.Table 1Table 2Figure 1Disclosures:Seifeldin Hakim indicated no relevant financial relationships. Emmanuel Coronel indicated no relevant financial relationships. Philip Ge indicated no relevant financial relationships. Suresh Chari indicated no relevant financial relationships. Nirav Thosani indicated no relevant financial relationships. Srinivas Ramireddy indicated no relevant financial relationships. Ricardo Badillo indicated no relevant financial relationships. Tomas DaVee indicated no relevant financial relationships. Marc Catalano indicated no relevant financial relationships. Robert Sealock indicated no relevant financial relationships. Sreeram Parupudi indicated no relevant financial relationships. Lyndon Hernandez indicated no relevant financial relationships. Virendra Joshi indicated no relevant financial relationships. Atsushi Irisawa indicated no relevant financial relationships. Surinder Rana indicated no relevant financial relationships. Sundeep Lakhtakia indicated no relevant financial relationships. Peter Vilmann indicated no relevant financial relationships. Adrian Saftiou indicated no relevant financial relationships. Siyu Sun indicated no relevant financial relationships. Marc Giovannini indicated no relevant financial relationships. Matthew Katz indicated no relevant financial relationships. Michael Kim indicated no relevant financial relationships. Graciela Nogueras-Gonzalez indicated no relevant financial relationships. Manoop Bhutani indicated no relevant financial relationships.

P0130 (S0136). Not Such a Fluid Concept – A Quality Improvement Initiative in Pancreatitis Care at a Tertiary Academic Center 1390163 Nicholas Ludvik University of South Alabama Not Such a Fluid Concept – A Quality Improvement Initiative in Pancreatitis Care at a Tertiary Academic Center Biliary/Pancreas ePoster Session Nicholas R. Ludvik, MD, Lauren Loeb, BS, Yazan Fahmawi, MD, Gabriel Bolanos-Guzman, MD, Abrahim Hanjar, MD, Jessica Houston, DO, Kyle Humphrey, MD, Michael Lysek, MD, Gilad Shapira, DO, Meir Mizrahi, MD; University of South Alabama, Mobile, ALIntroduction: As of 2016, acute pancreatitis (AP) was responsible for $2.5 billion in health care costs (NEJM). It is among the most common gastrointestinal reasons for hospitalization and incidence is increasing (NEJM). Consequently, its management represents a prime target for optimization of quality of care to minimize unnecessary spending. Methods: IRB approval obtained. Patient data from October 1, 2017 to April 30, 2019, obtained for patients with international classification of disease codes for pancreatitis, including chronic and acute. Variables studied included published guideline metrics for quality of pancreatitis care. Grand rounds presentation was delivered to internal medicine department in which institutional performance was integrated into guideline review. Knowledge acquisition assessed with survey before and after lecture. Patient data was collected again beginning from date of presentation. Results: Pre-intervention data yielded pool of 772 patients with 1118 encounters. Patients not admitted or without pancreatitis excluded, yielding 239 patients over 316 encounters. Survey data from grand rounds indicated significant improvement in participant score regarding ordering ultrasound not CT to assess for biliary etiology (p=5.61x10^-10), promoting early enteral feeding (p=4.22x10-6), prescribing low fat diet (p=0.05), and performing cholecystectomy prior to discharge for gallstone pancreatitis (p=0.003). Performance data review indicates significantly decreased time to feed (p=0.04, from mean 28 to 17 hours, standard deviation (SD) 7.78). Values not reaching significance but showing considerable trending towards improvement include: decreasing lipase draws (p=0.36, mean decreased 1.97 to 1.58, SD 0.28), length of stay (p=0.44, mean decreased from 155.5 to 103.7 hours, SD 36.63), cholecystectomy prior to discharge (p=0.94, mean increased from 0.58 to 1, SD 0.30), and follow up with gastroenterology (p=0.06, mean increased from 0.18 to 0.5, SD 0.23). Discussion: Data collected thus far indicates improvement in both knowledge and performance in several quality metrics. Further study is needed to further validate our findings, particularly in the acquisition of further post intervention data as there was a considerable decrease in the number of patients admitted to our institution for pancreatitis since the advent of COVID 19. Data thus far appears to indicate that a low cost intervention can be utilized to promote increased awareness and possibly effect better care at reduced cost. Disclosures:Nicholas Ludvik indicated no relevant financial relationships. Lauren Loeb indicated no relevant financial relationships. Yazan Fahmawi indicated no relevant financial relationships. Gabriel Bolanos-Guzman indicated no relevant financial relationships. Abrahim Hanjar indicated no relevant financial relationships. Jessica Houston indicated no relevant financial relationships. Kyle Humphrey indicated no relevant financial relationships. Michael Lysek indicated no relevant financial relationships. Gilad Shapira indicated no relevant financial relationships. Meir Mizrahi indicated no relevant financial relationships.

P0370 (S0151). Detection and Mutational Analysis of SARS-CoV-2 From Patient Fecal Samples by Whole Genome Sequencing 1390300 Sabine Hazan ProgenaBiome Detection and Mutational Analysis of SARS-CoV-2 From Patient Fecal Samples by Whole Genome Sequencing Colon ePoster Session Sabine Hazan, MD, Andreas Papoutsis, PhD, Brad Barrows, DO; ProgenaBiome, Ventura, CAIntroduction: In this study we sought to identify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by next generation sequencing (NGS) from fecal collections. We also aimed to characterize unique SARS-CoV-2 genome variations among the patients to capture viral evolution that may be occurring in the populationMethods: Study participants (n = 10) underwent testing for SARS-CoV-2 from fecal samples by NGS. Following fecal collection,RNA was extracted, reverse transcribed, enriched, and sequenced on Illumina’s NextSeq 550 System. Sequences were mapped to the SARS-CoV-2 Wuhan-Hu-1 (MN90847.3) genome utilizing One Codex’s SARS-CoV-2 analysis pipeline. SARS-CoV-2 positive samples were further analyzed for mutational variants that differed from the reference genome. 8 study participants had their nasopharyngeal swabs tested for SARS-CoV-2 by real-time polymerase chain reaction (rt-PCR).Results: Of the 10 study participants, seven tested positive for SARS-CoV-2 by rt-PCR, one asymptomatic individual tested negative, and two did not undergo rt-PCR testing (Fig. 1). The concordance of SARS-CoV-2 detection by NGS from stools among positive patients by rt-PCR nasopharyngeal analysis was 85.7% (6/7). Patient 8, who did not undergo nasopharyngeal analysis, was positive by NGS. Asymptomatic patients 9 and 14, were negative by NGS.All positive samples analyzed by NGS achieved 100% genome coverage of SARS-CoV-2 except for patient 10’s sample, which had 93% coverage (Fig. 2). SARS-CoV-2 variants at positions 241 (C → T) and 3037 (A → C) were found across all positive patients, and variants at positions 23403 (A → G) and 25563 (G → T) were each found among six of the seven patients (Fig 3). Patient 1 harbored the most unique SARS-CoV-2 genome, with six variants not found in any of the other individuals. Figure 3 highlights the 4 distinct SARS-CoV-2 genomes among the 7 patients, with a total of 23 different mutations. Interestingly, 6 of the patients all harbored a mutation at position 23403, in the spike glycoprotein region, involved in ACE2 receptor binding.Discussion: Although previous studies have identified SARS-CoV-2 in fecal collections by rt-PCR, this is the first study to our knowledge, to report whole genome sequencing (WGS) of SARS-CoV-2 from stool samples. The ability of NGS to identify unique genomic differences among fecal collections, may provide an alternative source for COVID-19 identification, and tracking of its evolutionary progression through the population.Comparison of patients’ SARS-CoV-2 rt-PCR test results from nasopharyngeal swab samples and SARS-CoV-2 NGS results from fecal samples.Disclosures:Sabine Hazan: ProgenaBiome – Stockholder/Ownership Interest (excluding diversified mutual funds), CEO/Founder.Andreas Papoutsis: ProgenaBiome – Employee.Brad Barrows: ProgenaBiome – Employee.

P0380 (S0161). Novel Monoclonal Antibodies in Late Phase Development for Ulcerative Colitis: A Systematic Review 1388259 Gilles Hoilat SUNY Upstate Medical University Novel Monoclonal Antibodies in Late Phase Development for Ulcerative Colitis: A Systematic Review Colon ePoster Session Gilles J. Hoilat, MBBS, Seren Durer, MD, Ceren Durer, MD, Divey Manocha, MD; SUNY Upstate Medical University, Syracuse, NYIntroduction: Patients with moderate to severe Ulcerative Colitis (UC) who are refractory or intolerant to standard treatment regimen such as tumor necrosis factor-α inhibitors or immunomodulators (azathioprine) are difficult to treat population. Novel therapeutic approaches are evolving to improve the outcomes of these patients. This review aims to summarize phase II/III trials using monoclonal antibodies (mAb) for the treatment of UC unresponsive to standard regimens.Methods: A comprehensive literature search was performed using PubMed, Embase, Web of Science and Clinicaltrials.gov for identification of late phase (II/III) trials of mAbs for UC treatment. FDA-approved mAbs were excluded. Studies were selected based on PRISMA guideline.Results: A total of 378 studies were identified and five studies (n=783 patients) met our inclusion criteria. Antibodies directed against IL-23 (mirikizumab), α4β7 and αEβ7 integrins (Etrolizumab), MAdCAM-1 (ontalimumab) were included. The results of clinical response, clinical remission and endoscopic remission are depicted in table 1. The Mayo and Partial Mayo scoring system defined by endoscopic score (ES), and patient-reported rectal bleeding (RB) and stool frequency (SF) was used.Etrolizumab: In the EUCALYPTUS study, no patients in the placebo group had clinical remission at week 10, compared with 21% patients in the 100 mg group and 10% patients in the 300 mg plus loading dose (LD) group. Furthermore, no placebo group had endoscopic remission at week 10, compared to 10% in the 100 mg group and 8% patients in the 300 mg plus LD group. In the HICKORY Study, 50.8% of the patients receiving 105 mg had a clinical response; 12.3% achieved clinical remission and 23.9% achieved endoscopic remission at week 14.Ontamalimab: In TURANDOT study, clinical remission rates at week 12 were reported in 23.9% (7.5 mg group), 40.3% (22.5mg group), 36.6% (75 mg group), 25.7% (225 mg group) of patients.Mirikizumab: At week 12, 15.9%, 22.6%, and 11.5% of patients in the 50mg, 200mg, and 600mg groups achieved clinical remission, respectively, compared with 4.8% of patients who received placebo. Clinical responses occurred in 41.3%, 59.7%, and 49.2% of patients in the 50 mg, 200 mg, and 600 mg groups, respectively, compared with 20.6% of patients given placebo.Discussion: Novel mAbs for moderate to severe UC showed promising results. Further studies are required to explore the efficacy and safety of mAb. Ongoing studies for guselkumab, brazimumab, risankizumab are active.Percentage of clinical Remission in patient taking Mirikizumab, Etrolizumab, and OntamalimabDisclosures:Gilles Hoilat indicated no relevant financial relationships. Seren Durer indicated no relevant financial relationships. Ceren Durer indicated no relevant financial relationships. Divey Manocha indicated no relevant financial relationships.

P0390 (S0171). Recent Trends of Complicated Diverticulitis in Philadelphia: 2002-2018 1388286 Brenda French Thomas Jefferson University Hospital Recent Trends of Complicated Diverticulitis in Philadelphia: 2002-2018 Colon ePoster Session Brenda French, MD1, Christine Shieh, MD1, Caroline Johnson, MD2; 1Thomas Jefferson University Hospital, Philadelphia, PA; 2Philadelphia Department of Public Health, Philadelphia, PAIntroduction: Due to increased incidence of diverticulitis and its complications creating a burden on the national healthcare system, there has been a shift towards a more conservative approach to treat diverticular disease in the past few years. We aimed to define the effects of these management changes by performing a survey of hospitalizations related to diverticulitis in a large, urban city to better understand recent trends in diverticulitis admissions.Methods: Inpatient data collected by the Pennsylvania Health Care Cost Containment Council (PHC4) was used for retrospective analysis of 20,260 hospitalizations from 2002 to 2018 at acute care hospitals in Philadelphia where the primary diagnosis for admission was diverticulitis. From these admissions, complications were identified by primary or secondary diagnosis codes listing diverticular abscess, hemorrhage, perforation, obstruction, and/or fistula.Results: Between 2002 and 2018, diverticulitis was responsible for 20,260 hospitalizations within Philadelphia. Complicated diverticulitis (n=5,825) surpassed uncomplicated diverticulitis (n=14,425) in recent years with a 46.1% decrease in uncomplicated diverticulitis admissions and a 121.5% increase in complicated diverticulitis admissions. Most change occurred from 2014 onwards (Figure 1). Of the complications, abscesses have increased by 472.7% and represent the most common complication of diverticulitis (n=3,575)(Figure 2). Upon closer analysis, several complications of diverticulitis were positively associated with the occurrence of abscesses. These included perforation (OR=2.60; 95% CI= 1.95-3.46), obstruction (OR=2.25; 95% CI=1.97-2.57), and fistula (OR=9.46; 95% CI=7.24-12.36), but not hemorrhage.Discussion: We hypothesize that the surge in complicated diverticulitis and diverticular abscesses may be due to a failure in conservative management, especially with the movement to discontinue antibiotic use in select uncomplicated diverticulitis cases. This temporal overlap suggests that antibiotics may play a crucial role in preventing long-term complications of acute diverticulitis. In addition, abscesses appear to be strongly associated with all other complications of diverticulitis except for hemorrhage, supporting the notion that abscesses may be a precursor to further sequelae. Therefore, early detection of abscesses is important to prevent progression to more life-threatening complications.Figure 1. Number of hospitalizations with diverticulitis as primary diagnosis in the Philadelphia area between 2002-2018, further subdivided into uncomplicated and complicated diverticulitis.Figure 2. Number of hospitalizations with complications of diverticulitis including abscess, perforation, hemorrhage, obstruction, and fistula as primary diagnosis in the Philadelphia area between 2002-2018.Table 1. Total number, average age (+/- S.D.), and number/percentage female gender of hospitalizations with diverticulitis and its complications in the Philadelphia area from 2002 to 2018.Disclosures:Brenda French indicated no relevant financial relationships. Christine Shieh indicated no relevant financial relationships. Caroline Johnson indicated no relevant financial relationships.

P0400 (S0181). Understanding Regional Trends and Discrepancies of Anal Cancer in the USA: Should We Look West to California? 1388013 Anas Raed AUMC Understanding Regional Trends and Discrepancies of Anal Cancer in the USA: Should We Look West to California? Colon ePoster Session Anas Raed, MD1, Mahima Zandu, MBBS2, Amol Sharma, MD, MS, FACG1, Humberto Sifuentes, MD1, Subbaramiah Sridhar, MBBS, MPH, FRCP, FRCPC, FACG1; 1AUMC, Augusta, GA; 2Mahatma Gandhi Medical College, Jhamshedpur, Jharkhand, IndiaIntroduction: Anal cancer (AC) is an uncommon malignancy and therefore its epidemiology is poorly understood. Recent data suggests an increase in incidence of AC in the United States (US), but the regional distribution of this disease is unknown. Our aim of this study was to determine the incidence rate variations of AC by geographic location, specifically by regions and states. Methods: Data was extracted from National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology and End Results (SEER) for the period 2001-2017. Age-adjusted incidence and annual percent change (APC) were calculated in a step-wise manner to examine the trends among each of four US regions, followed by 13 individual SEER-reported states. SEER Stat software was used to analyze the data.Results: The incidence rates of AC in population >50 years have significantly increased in all US regions, with the lowest rates of increased incidence in the West with APC of 1.8 (CI: 1.2, 2.3) (table 1). While incidence rates of AC in population < 50 years have remained stable, a significant decrease was observed in the West region with an APC -2.2 (CI: -3.3, -1.1). When examining incidence rates of AC in population >50 years by states, the rates have increased significantly in all 13 SEER-reported states except New Mexico and Utah with the highest increase in Iowa with APC 4.2 (CI: 2.7, 5.8) (table 2). While there is an upward trend in population < 50 years, Kentucky and Louisiana demonstrated the largest increase in incidence, APC 4.0 (CI: 1.5, 6.5) and 2.6 (CI: 0.3, 4.9). Only California demonstrated a significant decrease in incidence in population < 50 years with an APC -2.5 (CI: -3.5, -1.4).Discussion: This study illustrates troubling increasing incidence of AC nationwide and noteworthy discrepancies of AC incidence rates by geographic location. Further efforts should focus on widespread adoption of public health preventive, screening, and surveillance strategies broadly across the country to impact the troubling rising incidence of AC. Public health organizations should closely examine the West region and the state of California to understand and adopt successful practices to mitigate rising rates of AC. Disclosures:Anas Raed indicated no relevant financial relationships. Mahima Zandu indicated no relevant financial relationships. Amol Sharma indicated no relevant financial relationships. Humberto Sifuentes indicated no relevant financial relationships. Subbaramiah Sridhar indicated no relevant financial relationships.

P0410 (S0191). Comparing Pathologic Features of Different Colonic Segments in Non-Hereditary Young Onset Colorectal Cancer 1387736 Shravani Reddy Carilion Clinic Comparing Pathologic Features of Different Colonic Segments in Non-Hereditary Young Onset Colorectal Cancer Colon ePoster Session Shravani R. Reddy, MD1, Mohamad Mouchli, MD1, Lindsey A. Bierle, DO1, Shravani R. Reddy2, Adil S. Mir, MD1, Christopher Walsh, MD3, Christopher Mason, PA-C2, David P. LeBel, II, MD2, Douglas J. Grider, MD2, Marrieth G. Rubio, MD1; 1Carilion Clinic, Roanoke, VA; 2Virginia Tech Carilion School of Medicine, Roanoke, VA; 3Virginia Tech Carilion, Roanoke, VAIntroduction: Young patients with non-hereditary colorectal cancer (CRC) have unfavorable pathologic characteristics. The features and survival outcomes in different colonic segments are to be determined.Methods: In this retrospective observational study we randomly selected patients (aged 18- 50) with a histopathologic diagnosis of CRC at Carilion Clinic, Roanoke, from 2002 to 2017. Patients with inflammatory bowel disease and predisposing genetic syndromes were excluded. Demographics, polyp and tumor features, and mortality were obtained from the electronic medical record. Two pathologists reviewed histopathology to minimize diagnostic variability. The cumulative risk of mortality among patients with different pathologic features was estimated using Kaplan Meier curves. Results: We identified 139 patients (Mean age, 41.6±6.9 years; 53.2% males) with non-hereditary CRC. Thirty percent of tumors were located in the right colon (RC), 35.4% in the left colon (LC), and 34.5% in the rectum (Rec). In patients with resected tumors, a cancer-adjacent polyp was identified in 78.8% (RC), 73.7% (LC), and 47.4% (Rec). Lymphovascular invasion (LVI) was present in 59.0% compared to 38% (LC) and 25% (Rec). Perineural invasion (PNI) was present in 25.0% compared to 10.8% (LC) and 14.35% (Rec). RC tumor budding was (14%) compared to 13.1% (LC) and 2.9% (Rec), and tumor deposits in 30% compared 18.9% (LC) and 17.7% (Rec). Intratumoral lymphocytes were present in 32.1% (RC) compared to 15.8% (LC) and 3.03% (Rec). Intratumoral neutrophils were present in 3.6% in the RC compared to 10.5% (LC) and 3.03% (Rec). Thirty-two percent (RC) had Crohn’s like response compared to 26.3% (LC) and 3.0% (Rec). Microsatellite instability (MSI) accounted for 9.4% of (RC) tumors and 8.1% of (LC) tumors but was not present in rectal tumors. Among patients who had repeat colonoscopy for surveillance, about 90.0% of patients with RC cancer did not receive surveillance colonoscopy within 1 year of cancer diagnosis compared to 42% (LC) and 55.6% (Rec). Patients with Rec cancer had decreased survival compared to patients diagnosed with RC and LC cancers (P=0.04) (Figure1). Discussion: Right colon tumors accounted for higher rates of unfavorable pathologic features compared to left colon and rectal tumors. Adherence to USMSTF surveillance recommendations is poor, especially in RC tumors. Patients with rectal cancer had the poorest survival outcomes compared to right and left colon tumors.Figure 1. Interval time of diagnosis until last visit based on segmentDisclosures:Shravani Reddy indicated no relevant financial relationships. Mohamad Mouchli indicated no relevant financial relationships. Lindsey Bierle indicated no relevant financial relationships. Shravani Reddy indicated no relevant financial relationships. Adil Mir indicated no relevant financial relationships. Christopher Walsh indicated no relevant financial relationships. Christopher Mason indicated no relevant financial relationships. David LeBel indicated no relevant financial relationships. Douglas Grider indicated no relevant financial relationships. Marrieth Rubio: Gilead – Grant/Research Support.

P0420 (S0201). Crosstalk of Multi-Omics Reveals Specific Characteristics in Active Ulcerative Colitis Patients With Depression and Anxiety 1388495 Xiaomin Yuan Affiliated Hospital of Nanjing University of Chinese Medicine Crosstalk of Multi-Omics Reveals Specific Characteristics in Active Ulcerative Colitis Patients With Depression and Anxiety Colon ePoster Session Award: Presidential Poster AwardXiaomin Yuan, MD, Biqing Chen, PhD, Jin-Yong Zhou, PhD, Shijia Liu, PhD, Guoping Shi, PhD, Lei Zhu, MD, Yugen Chen, MD; Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, ChinaIntroduction: Ulcerative colitis (UC) patients are accompanied by a high proportion of mental disorders, such as anxiety and depression, especially in the active stage. UC and mental disorders are separately reported to be related with gut microbiota imbalance. The microbiota-gut-brain axis dysfunction is considered as one important pathogenesis of mental diseases. At present, little is known about how gut microbiota interact with the host in UC-related depression and anxiety.Methods: This prospective observational study enrolled 240 Chinese patients in two cohorts: the discovery cohort included 69 active UC patients, 49 non-UC depression and anxiety patients, and 62 healthy people, and the replication cohort includes 60 active UC patients. Patient Health Questionnaire-9 and Generalized Anxiety Disorder Questionnaire were used to evaluate the depression and anxiety level, respectively. Gut microbiota for all subjects were analyzed by 16s rRNA sequencing of feces. Serum metabolome and proteome for the replication cohort were analyzed using liquid chromatography/ mass spectrometry. Six statistical analysis methods were implemented and multi-omics correlation analyses were performedResults: The prevalence rates of depression and anxiety in active UC patients were 55.07% and 47.83%, respectively. Patients with active UC accompanied by depression and anxiety had lower fecal microbial abundance with more Sellimonas, Eubacterium ventriosum group and Peptoclostridium, but less Prevotella_9 and Dorea, compared with non-depressed/ anxious UC patients. 1-stearoyl-sn-glycerol, 1-Stearoyl-rac-glycerol, 3-Indolepropionic acid and Dopamine increased, while 2'-deoxy-D-ribose and CRKL protein significantly decreased in the serum of UC patients accompanied by depression and anxiety. These gut bacteria, serum metabolites and proteins significantly associated with UC-related depression and anxiety are closely correlated with each other, forming a highly connected and interactive network, centering on Prevotella_9 and 1-stearoyl-sn-glycerol.Discussion: In conclusion, we have identified a set of gut microbiota, serum metabolites and proteins specifically related to depression and anxiety in active UC, and revealed a highly connected and interactive multi-omics network involved in UC-specific depression and anxiety. These findings suggest potential targets (bacteria, metabolites, proteins) for auxiliary diagnosis and clinical intervention of mental disorders in patients with active UC.Suggested model of the gut microbiota contribution to serum metabolite and protein levels and UC depression and anxiety phenotype. Serum metabolite and protein levels are influenced by microbiota and their interactions. These changes together may influence the brain and then depression and anxiety level in UC patients.Disclosures:Xiaomin Yuan indicated no relevant financial relationships. Biqing Chen indicated no relevant financial relationships. Jin-Yong Zhou indicated no relevant financial relationships. Shijia Liu indicated no relevant financial relationships. Guoping Shi indicated no relevant financial relationships. Lei Zhu indicated no relevant financial relationships. Yugen Chen indicated no relevant financial relationships.

P0430 (S0211). Emerging Evidence for Frequent Occurrence of Clostridioides difficile-Associated Diarrhea in Untreated Symptomatic Clostridioides difficile Carriers 1389994 Sandeep Verma Sinai Hospital of Baltimore Emerging Evidence for Frequent Occurrence of Clostridioides difficile-Associated Diarrhea in Untreated Symptomatic Clostridioides difficile Carriers Colon ePoster Session Sandeep Verma, MBBS, MD1, Denise Arrup, BSN, RN, CGRN1, Rakesh Vinayek, MD, FACG1, Padmanabhan P. Nair, PhD2, Laila Phillips, BA1, Elad Firnberg, PhD1, Sudhir K. Dutta, MD, MACG1; 1Sinai Hospital of Baltimore, Baltimore, MD; 2Johns Hopkins University, Baltimore, MDIntroduction: Currently, the diagnosis of Clostridioides difficile infection(CDI) is based on stool testing for the detection of C.diff glutamate dehydrogenase antigen(Ag), C.diff toxin(A or B), and toxin gene sequences(PCR, Amplified test). The sensitivity and specificity of these tests ranges between 90-99%. The results are interpreted as Ag (+/-) Toxin (+/-) and Amplified (+/-). Based on these results, the patients are classified as having C.diff infection, C.diff carriers or C.diff negative. The subset of patients who are Ag(+)Toxin(-) and Amplified(-) are classified as C.diff carriers. To date, there are no guidelines for management of symptomatic C.diff carriers, nor is there a longitudinal follow up of these patients in the literature.Methods: A retrospective study was conducted for all the patients who were admitted for or developed diarrhea and who tested positive for C.diff Antigen (n=86) between July, 2017- June, 2018.Results: Of the 86 patients, 29 were Ag(+) Toxin(+) and 35 were Ag(+) Toxin(-) Amplified(+), these group of patients were identified as having CDI and were treated. However, a subset of patients(n=22) who were Ag(+) Toxin(-) Amplified(-) who were symptomatic, were classified as Symptomatic C.diff carriers (Table 1). The mean age of this subgroup was 59.3 years(+/- 24.2 years, SD) and it consisted of 10 males and 12 females. It is noteworthy, that 19 out of these 22 symptomatic carriers were not given any antibiotic treatment. A longitudinal follow up of this group of patients, for a period of 6-12 months revealed that 6 out of these 22 C.diff carriers went on to develop CDI and requiring multiple admissions(1-3) to the hospital.Discussion: As many as 22 out of 86 patients were identified as symptomatic C.diff carriers, and the majority of these patients (86.3%) went untreated. The prevalence of the symptomatic carrier is quite significant (25.6%) in our study population. Of the untreated symptomatic C.diff carriers, six patients(27.3%) developed subsequent CDI and required readmissions to the hospital(1-3) within 6-12 months. The cost of a single hospitalization due to a single incidence of CDI is roughly $43,000. These data suggest that symptomatic C.diff carriers should be treated with antibiotics to prevent CDI and readmission to the hospital. Additional prospective clinical studies on larger group of patients with longitudinal follow up are needed for optimum guidelines for the management of this group of patients.Table 1Disclosures:Sandeep Verma indicated no relevant financial relationships. Denise Arrup indicated no relevant financial relationships. Rakesh Vinayek indicated no relevant financial relationships. Padmanabhan Nair: Noninvasive Biotechnologies – Advisory Committee/Board Member, CEO.Laila Phillips indicated no relevant financial relationships. Elad Firnberg indicated no relevant financial relationships. Sudhir Dutta indicated no relevant financial relationships.

P0440 (S0221). Do Racial and Gender Disparities Exist in Young Onset Rectal Carcinoma? Untold Story of Ten Years 1390373 Hafiz Muhammad Sharjeel Arshad Medical College of Georgia Do Racial and Gender Disparities Exist in Young Onset Rectal Carcinoma? Untold Story of Ten Years Colon ePoster Session Award: ACG/Naomi Nakao Gender-Based Research AwardAward: Presidential Poster AwardHafiz Muhammad Sharjeel Arshad, MD1, Ayesha Cheema, MBBS2, Ayesha Arshad, MBBS3, Nouman Akbar, MD4, Pearl Princess Uy, MD1, Humberto Sifuentes, MD5, John Erikson L. Yap, MD6; 1Medical College of Georgia, Augusta, GA; 2Sargodha Medical College, North Augusta, SC; 3Fatima Memorial Hospital, Lahore, Punjab, Pakistan; 4Johns Hopkins Community Physicians, Howard County General Hospital, Columbia, MD; 5AUMC, Augusta, GA; 6Medical College of Georgia at Augusta University, Augusta, GAIntroduction: Increasing incidence and mortality of young onset colorectal carcinoma (YOCRC) has become a concerning major healthcare issue in recent years. Recently published data suggests increase in incidence of YOCRC in recent years is primarily due to increase in incidence of rectal cancer especially in Non-Hispanic Whites. Also, no racial disparities were suggested in survival of young onset rectal cancer (YORC). Our study aimed to investigate recent trends in incidence and survival of rectal carcinoma in young (< 50 years) patients and investigate racial disparities.Methods: Using data from the Surveillance, Epidemiology, and End Results 18 (SEER) program of cancer registries, we gathered 10 years (2007-2016) data on YORC in the US. Racial disparities in YORC incidence rate were calculated using SeerStat© and SPSS© descriptive statistics tool. Racial disparities in YORC-associated survival times were collected using SEER 13 registries (2007-2016) and calculated using Ederer II method.Results: Relatively higher incidence of advanced (stage IV) malignancy was noted in Non-Hispanic Whites (NHW) compared to other racial groups (Non-Hispanic Whites=1.9%, Non-Hispanic Blacks (NHB)=1.3%, Hispanic =1.3%) (Table 1). In most racial groups, females tend to have higher incidence rate of YORC (Table 1). Relative survival rates for all the racial groups were found to be 94% at 12 months and 73% at 60 months. Significant racial disparities were noted in relative survival of minority racial groups compared to NHW (NHW=74.2 %, NHB=68.2%, Hispanic=63.1%) (p < 0.05) (Fig 1, Table 2).Discussion: Although minority racial groups have relatively lower incidence rates of advanced YORC, their survival rates are significantly poor compared to NHW. Different factors like access to health care, response to treatment, genetics and socioeconomic factors may be contributing to these observed differences. Further research is required to investigate these factors and help win fight against rectal carcinoma especially in young patients.Table 1. Racial and gender disparities in different grades of rectal carcinomaTable 2. Racial and gender disparities in 1 and 5 years survival rate of young onset rectal carcinomaFig 1. Graphical representation of racial disparities in 1 and 5 years survival rate of young onset rectal carcinomaDisclosures:Hafiz Muhammad Sharjeel Arshad indicated no relevant financial relationships. Ayesha Cheema indicated no relevant financial relationships. Ayesha Arshad indicated no relevant financial relationships. Nouman Akbar indicated no relevant financial relationships. Pearl Princess Uy indicated no relevant financial relationships. Humberto Sifuentes indicated no relevant financial relationships. John Erikson Yap indicated no relevant financial relationships.

P0450 (S0231). Preventing Post-Polypectomy Bleeding Using Prophylactic Clip Closure: A Systematic Review and Meta-Analysis 1390053 Umair Iqbal Geisinger Medical Center Preventing Post-Polypectomy Bleeding Using Prophylactic Clip Closure: A Systematic Review and Meta-Analysis Colon ePoster Session Umair Iqbal, MD1, Osama Siddique, MD2, Harshit S. Khara, MD, FACG1, Hafsa Anwar, MD3, Khwaja F. Haq, MD4, Muhammad A. Karim, MD5, Muhammad Ali Khan, MD6, John W. Birk, MD2; 1Geisinger Medical Center, Danville, PA; 2University of Connecticut, Farmington, CT; 3Capital Health Medical Center, Hopewell Township, NJ; 4Henry Ford Hospital/Wayne State University, Detroit, MI; 5Imam Clinic, Karachi, Sindh, Pakistan; 6University of Alabama, Birmingham, ALIntroduction: Delayed post-polypectomy bleeding (DPPB) is a common complication after colonoscopic polypectomy, and recent guidelines have somewhat cleared the muddy waters. The size of the polyp which qualifies for prophylactic clip closure to prevent DPPB still remains debated. This study aimed to review prophylactic clip placement on polyps >1 cm in reducing DPPB.Methods: We conducted a systematic literature search on several databases including PubMed, Embase and Ovid Medline until January 2020 to identify all potential studies that evaluated the utility of prophylactic clipping in decreasing the risk of DPPB. All the analysis was performed using RevMan 5.3 software.Results: Twenty-nine studies [17 randomized controlled trials (RCTs) and 12 observational studies] with 24,280 patients were included in the meta-analysis. Out of 24,280, 7478 patient had clipping done and 16802 had no prophylactic clipping done. There was no significant difference in risk of DPPB in patients who had clipping and no clipping with OR=1.16 [0.68-1.99] with significant heterogeneity (I2=80%). In a subgroup analysis, six studies including 3249 patients with >1 cm non-pedunculated polyp was included to evaluate if prophylactic clipping has any benefit in lowering the risk of DPPB. Clipping was performed in 1525 patient and 1724 patients had no clipping done. Prophylactic clipping is associated with lower odds of DPPB with OR=0.66 [0.45-0.99] with no heterogeneity. In another subgroup analysis including only RCTs, prophylactic clipping is associated with lower odds of DPPB with OR=0.74 [0.47-1.15]. Risk of DPPB is significantly higher in patients on anticoagulation or dual antiplatelets therapy with OR=2.96 [2.22-3.94] and use of prophylactic clipping will be beneficial is these patients.Discussion: In contrast to previous studies, our review and analysis of literature reflect that patients with polyp > 1 cm had a significant reduction in DPPB with prophylactic clip closure. It also found no significant reduction in DPPB between prophylactic clip closure of right versus left colon polyps. Our study raises new questions on whether an approach of reserving prophylactic clipping of large ( > 2 cm) polyps might result in a higher complication rate with DPPB.Disclosures:Umair Iqbal indicated no relevant financial relationships. Osama Siddique indicated no relevant financial relationships. Harshit Khara indicated no relevant financial relationships. Hafsa Anwar indicated no relevant financial relationships. Khwaja Haq indicated no relevant financial relationships. Muhammad Karim indicated no relevant financial relationships. Muhammad Ali Khan indicated no relevant financial relationships. John Birk indicated no relevant financial relationships.

P0460 (S0241). American College of Gastroenterology (ACG) Guidelines for Classification of Severity in Colonic Ischemia (CI) Is Useful in Predicting Mortality and Other Adverse Outcomes 1389127 Karthik Gnanapandithan Mayo Clinic American College of Gastroenterology (ACG) Guidelines for Classification of Severity in Colonic Ischemia (CI) Is Useful in Predicting Mortality and Other Adverse Outcomes Colon ePoster Session Karthik Gnanapandithan, MD, MS1, Olga Aroniadis, MD, MSc2, Lawrence J. Brandt, MD, MACG3, Sohail Mansoor, MD4, Abdul Bhutta, MD5, Michael Silverman, MD6, Marc Fenster, MD7, Paul Feuerstadt, MD8; 1Mayo Clinic, Jacksonville, FL; 2Stony Brook University School of Medicine, Stony Brook, NY; 3Montefiore Medical Center, Bronx, NY; 4Albany Medical Center, Albany, NY; 5State University of New York Upstate Medical Center, Syracuse, NY; 6Cleveland Clinic Foundation, Cleveland, OH; 7Mount Sinai Hospital, New York, NY; 8Yale University, School of Medicine, Hamden, CTIntroduction: The presentation, natural history and prognosis of CI vary based upon severity: mild cases improve with supportive care and severe disease requires urgent surgical evaluation. The ACG guidelines recommended triaging pts into three categories: mild, moderate and severe (Figure 1) based upon factors associated with increased 30-day mortality and colectomy, but this rating schema was created based on expert opinion and limited data. By applying this classification system to an inpatient population with CI, we hypothesize that those with severe disease are at greater risk of poor outcomes.Methods: We conducted a retrospective cohort study of pts with biopsy-proven CI admitted to Yale-New Haven Hospital and Montefiore Medical Center from 2005-2017. Baseline characteristics and outcomes were compared in pts with moderate and severe CI based upon the ACG schema. Multivariate logistic regression was used to predict binary outcomes adjusting for the Charlson Comorbidity Index (CCI). (SAS 9.4)Results: 838 pts met inclusion criteria. 407 and 418 had moderate and severe disease, respectively. Mild CI cases (n=4) were excluded from the analysis. Pts with severe CI were more frequently men (40.1% vs 13.5%, p< 0.0001) and had a higher CCI (5.7 vs 4.4, p< 0.0001). Those with severe CI were more likely to present with unstable hemodynamics (16.5% vs 1.0%, p< 0.0001), peritonitis (17.9% vs 0.0%, p< 0.0001), a higher proportion of small bowel involvement (13.2% vs 0.8%, p< 0.0001), right-sided colon involvement (51.2% vs 3.8%, p< 0.0001) and bowel necrosis (16.2% vs 0.0%, p< 0.0001) compared with moderate CI. Severe CI had higher 30-day mortality (9.6% vs 1.0%, p< 0.0001) and 30-day colectomy (26.1% vs 3.1%, p< 0.0001) rates. When adjusted for CCI, those with severe CI had a greater 30-day mortality (RR 8.7 (3.1-24.5), p< 0.0001), 30-day colectomy (RR 8.3 (4.6-14.8), p< 0.0001), ICU stay (RR 5.7 (3.9-8.3), p< 0.0001), 90-day recurrence (RR 5.3 (2.2-12.7), p=0.0002), 90-day readmission (RR 2.8 (2.0-3.9), p< 0.0001) and length of stay (5.02 days (SE 1.4), p< 0.0001) than those with moderate disease.Discussion: The ACG guideline severity classification of CI as moderate or severe is very effective in isolating those at greatest risk for poor outcomes. Based on this analysis, using this system for inpatients with CI is clinically relevant, and clinicians should consider classification according to these ratings. Further research is needed to guide therapy further according to this rating schema.Disclosures:Karthik Gnanapandithan indicated no relevant financial relationships. Olga Aroniadis indicated no relevant financial relationships. Lawrence Brandt indicated no relevant financial relationships. Sohail Mansoor indicated no relevant financial relationships. Abdul Bhutta indicated no relevant financial relationships. Michael Silverman indicated no relevant financial relationships. Marc Fenster indicated no relevant financial relationships. Paul Feuerstadt: Merck and Co. – Speaker's Bureau. Rebiotix-Ferring Pharmaceutical – Consultant. Roche Diagnostic – Consultant.

P0470 (S0251). Clostridioides difficile Infection Is Associated With Adverse Clinical Outcomes in Patients With Acute Diverticulitis: A Nationwide Study 1389224 Michael Makar Robert Wood Johnson Medical School Clostridioides difficile Infection Is Associated With Adverse Clinical Outcomes in Patients With Acute Diverticulitis: A Nationwide Study Colon ePoster Session Michael Makar, MD1, Debashis Reja, MD2, Savan Kabaria, MD3, Augustine Tawadros, MD2, Gabriel Makar, MD4, Weiyi Xia, BS5, Patricia Greenberg, MS5, Anish V. Patel, MD6; 1Robert Wood Johnson Medical School, New Brunswick, NJ; 2Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; 3Robert Wood Johnson Medical School, Rutgers University, Franklin Park, NJ; 4Geisinger Medical Center, Danville, PA; 5Biostatistics and Epidemiology Services Center, Rutgers School of Public Health, Piscataway, NJ; 6Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJIntroduction: Acute diverticulitis (AD) is a common gastrointestinal disease with a significant healthcare associated burden. Patients hospitalized with AD have many risk factors for developing Clostridioides difficile infection (CDI). CDI is associated with poor outcomes in many diseases but has yet to be studied in AD. Methods: We utilized data from the National Inpatient Sample from January 2012 – October 2015 for patients hospitalized with AD and CDI. Primary outcomes were mortality, length of stay, and hospitalization cost were compared. Secondary outcomes were complications of diverticulitis and need for surgical interventions. Risk factors for mortality in acute diverticulitis and risk factors associated with CDI in AD patients were analyzed.Results: Among 767,850 hospitalizations for AD, 8,755 also had CDI. A multivariate logistic regression analysis demonstrated that CDI was associated with increased risk of inpatient mortality (OR 2.02, 95% CI 1.38, 2.96), prolonged duration of hospitalization by 3.7 days (95% CI, 3.38, 4.02, p< .001) and had higher total hospitalization charges $74525 vs $37571 ( p< .001). Patients who required surgery for AD had greater mortality than those who did not (.9% vs .3%, p< .001). Patient with CDI in AD who underwent surgery had greater mortality than patients with CDI who did not require surgery (4.1% vs .9%, p< .001). Predictors of CDI among patients with AD included age (1.01 OR, 95% CI 1.01, 1.02) female gender (1.12 OR, 95% CI 1.01, 1.24), three or more comorbidities (1.81 OR, 95% CI 1.57, 2.09), admissions to teaching hospitals (1.44 OR, 95% CI 1.22, 1.70), length of stay (1.08, OR 95% CI 1.07, 1.09) and inflammatory bowel disease (2.26, 95% CI 1.61, 3.17).A multivariate logistic regression analysis for the impact of surgery and complicated diverticulitis was performed. Patients who required surgical interventions had increased mortality including colectomy (OR 2.36, 95% CI 1.83, 3.06), colostomy (OR 2.99, 95% CI 2.30, 3.90) anterior resection (OR 1.9, 95% CI 1.1, 3.29) and abscess drainage (OR 1.85, 95% CI 1.39, 2.47). Patients with complications of diverticulitis had increased mortality including obstruction (OR 1.33, 95% CI 1.07, 1.66), perforation (OR 3.90, 95% CI 2.16, 7.04) and hemorrhage (OR 1.73, 95% CI 1.38, 2.18).Discussion: CDI in AD is associated with increased mortality, length of stay and total hospital charges. Preventative measures should be made for at-risk patients with AD to decrease infection rate and poor outcomes.Table 1: Patient Demographics and Characteristics, Interventions, Complications and Outcomes of Acute Diverticulitis with and without CDITable 2: Risk factors associated with In-Hospital Mortality in Acute DiverticulitisDisclosures:Michael Makar indicated no relevant financial relationships. Debashis Reja indicated no relevant financial relationships. Savan Kabaria indicated no relevant financial relationships. Augustine Tawadros indicated no relevant financial relationships. Gabriel Makar indicated no relevant financial relationships. Weiyi Xia indicated no relevant financial relationships. Patricia Greenberg indicated no relevant financial relationships. Anish Patel indicated no relevant financial relationships.

P0480 (S0261). Does Bevacizumab Increase the Risk of Colonic Perforation With Placement Self-Expandable Metal Stents (SEMS) in Patients With Obstructive Colorectal Cancer? A Systematic Review and Meta-Analysis 1390072 Ayusa Sinha Geisinger Medical Center Does Bevacizumab Increase the Risk of Colonic Perforation With Placement Self-Expandable Metal Stents (SEMS) in Patients With Obstructive Colorectal Cancer? A Systematic Review and Meta-Analysis Colon ePoster Session Award: Presidential Poster AwardAyusa Sinha, MD1, Umair Iqbal, MD1, Harshit S. Khara, MD, FACG1, Hafsa Anwar, MD2, Khwaja F. Haq, MD3, Muhammad Ali Khan, MD4, Matthew Shellenberger, DO1, Mohammad Ismail, MD5; 1Geisinger Medical Center, Danville, PA; 2Capital Health Medical Center, Hopewell Township, NJ; 3Henry Ford Hospital/Wayne State University, Detroit, MI; 4University of Alabama, Birmingham, AL; 5University of Tennessee Health Science Center, Memphis, TNIntroduction: Self-expandable metal stents (SEMS) prevent the need for emergent surgery in patients with malignant colorectal obstruction (MCO). Colonic perforation is a risk factor for SEMs, which is heightened by the addition of bevacizumab, a monoclonal antibody shown to increase survival in colorectal cancer. However, some recent well-done studies showed no increased risk of colonic perforation with placement of SEMS in these patients on bevacizumab-based chemotherapy. We therefore conducted a systematic review and meta-analysis to evaluate the effect of bevacizumab on SEMS outcomes.Methods: We conducted a systematic literature search on several databases including PubMed, Embase and Ovid Medline until January 2020. We identified all potential studies that evaluated the risk of colonic perforation in patients with SEMS for MCO not on concomitant bevacizumab chemotherapy as compared to patients on bevacizumab chemotherapy. A random-effects model was utilized for this meta-analysis, with point estimates, variance and weights for each study based on the size of the study and the number of events. All the analysis was performed using RevMan 5.3 software.Results: Twenty-three studies including 2337 patients met our inclusion criteria and were included in the meta-analysis. Out of 2337 SEMS patients, 1961 were not on bevacizumab therapy and 376 received chemotherapy regimen consisting of bevacizumab. Bevacizumab therapy significantly increased the risk of colonic perforation in patients with MCO requiring SEMS placement with pooled OR=3.02 [1.48-6.17] with moderate statistical heterogeneity as calculated by I2=51%. In the randomized controlled trials (RCTs, N=2), there were no significant differences between the risk of perforation with SEMS placement in patients on bevacizumab compared to patients with SEMS placement not on bevacizumab with pooled OR=2.67 [0.24-29.20] with no heterogeneity I2=0%.Discussion: Our study showed bevacizumab significantly increases the risk of colonic perforation in patients with MCO who have undergone SEMS placement for the palliation of obstructive symptoms. This data will help both for the endoscopist placing the SEMS as well as the oncologist managing the chemotherapy to make an informed decision with the patient undergoing the treatment. Larger RCTs are needed to further delineate the association between increased risk of colonic perforation with SEMS placement in patients on bevacizumab chemotherapy.Disclosures:Ayusa Sinha indicated no relevant financial relationships. Umair Iqbal indicated no relevant financial relationships. Harshit Khara indicated no relevant financial relationships. Hafsa Anwar indicated no relevant financial relationships. Khwaja Haq indicated no relevant financial relationships. Muhammad Ali Khan indicated no relevant financial relationships. Matthew Shellenberger indicated no relevant financial relationships. Mohammad Ismail indicated no relevant financial relationships.

P0720 (S0277). Risk and Predictors of Colonic Polyps and Colorectal Cancer Among Barrett’s Esophagus Patients 1389692 Motasem Alkhayyat Cleveland Clinic Foundation Risk and Predictors of Colonic Polyps and Colorectal Cancer Among Barrett’s Esophagus Patients Colorectal Cancer Prevention ePoster Session Motasem Alkhayyat, MD1, Mohannad Abou Saleh, MD1, Mohammad Abureesh, MD2, Thabet Qapaja, MD1, Krishna Sanaka1, Ashraf Almomani, MD1, Adrian Lindsey, MD3, Mythri Anil Kumar, MD4; 1Cleveland Clinic Foundation, Cleveland, OH; 2Staten Island University Hospital, New York City, NY; 3University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH; 4Cleveland Clinic Foundation, Hartford, CTIntroduction: Barrett’s esophagus (BE) and colorectal cancer (CRC) share similar risk factors. Previous studies have shown variable prevalence of colonic polyps and CRC in patients with BE. Using a large multi-center database, we sought to describe the risk and predictors of colonic polyps and CRC among BE patients.Methods: We queried a multi-institutional database (Explorys Inc, Cleveland, OH, USA); an aggregate of electronic health record data from 26 US healthcare systems. A cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms of “Barrett’s Esophagus” 2016-2020, who underwent an upper endoscopy and colonoscopy was identified. Subsequently, another cohort of those who developed colonic polyps and Colorectal cancer was identified. Patients < 18 years old, history of inflammatory bowel disease, familial colorectal cancer syndromes, and familial polyposis syndromes were excluded. Cases were controlled with patients who underwent upper endoscopy and colonoscopy with no history of BE. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS version 25, IBM Corp). For all analyses, a 2-sided P value of < 0.05 was considered statistically significant.Results: Of the 39,328,760 individuals in the database, 3,665,190 (9.3%) underwent both an upper endoscopy and a colonoscopy. Among 89,210 (2.4%) individuals with history of BE, 25.3% had colonic polyps and 2.5% had CRC compared to 14.6% and 2.1% respectively in the control group, P< 0.0001. Baseline characteristics of cases and controls are shown in Table 1. Compared to the general population, patients with BE had higher association risk of colonic polyps [OR: 2.05 (2.02-2.08), P< 0.0001] as well as CRC [OR: 1.20 (1.16-1.24), P< 0.0001]. Among BE patients, predictors of having colonic polyps or CRC were age > 65 years, male gender, history of smoking, diabetes, and hyperlipidemia (Table 2).Discussion: In this large database, we found that BE patients have a two-fold increased risk of colonic polyps and a modest increased risk of CRC. This has important clinical implications for colon screening and surveillance in BE patients.Table 1: Baseline Characteristics of Cases and Control Groups. GERD; gastroesophageal reflux disease, PPI; proton pump inhibitors, H2-Blocker; histamine receptor blockerDisclosures:Motasem Alkhayyat indicated no relevant financial relationships. Mohannad Abou Saleh indicated no relevant financial relationships. Mohammad Abureesh indicated no relevant financial relationships. Thabet Qapaja indicated no relevant financial relationships. Krishna Sanaka indicated no relevant financial relationships. Ashraf Almomani indicated no relevant financial relationships. Adrian Lindsey indicated no relevant financial relationships. Mythri Anil Kumar indicated no relevant financial relationships.

P0730 (S0287). Incarceration Is Associated With Poor Adherence to Colorectal Cancer Screening in African American Men 1390348 Kenechukwu Chudy-Onwugaje University of Maryland School of Medicine Incarceration Is Associated With Poor Adherence to Colorectal Cancer Screening in African American Men Colorectal Cancer Prevention ePoster Session Kenechukwu Chudy-Onwugaje, MBBS, MPH, MS1, Sonia Abichandani, MD2, Arsheya Patel, MD3, Matthew Schliep, BSc1, Raymond K. Cross, MD, MS, FACG1; 1University of Maryland School of Medicine, Baltimore, MD; 2University of North Carolina, Chapel Hill, NC; 3The Ohio State University Wexner Medical Center, Columbus, OHIntroduction: In the United States (US), African-American (AA) men are disproportionately affected by colorectal cancer (CRC). They have higher incidence and mortality rates compared to all other groups, and this is in part due to their lower rate of adherence to CRC screening. AA men are also heavily impacted by incarceration in the US, with almost a third expected to spend time in prison in their lifetime. Given the significance of incarceration on the socialization of AA men in the US, it is vital to understand its impact on adherence to CRC screening. We aimed to investigate the association between prior incarceration and adherence to CRC screening in average-risk AA men in the US.Methods: This was a cross-sectional study involving AA men between the ages of 50 and 75 years in an urban center in the US. Those with a personal or family history of CRC were excluded. Surveys were administered to obtain information on demographics, experiences with incarceration, and CRC screening practices. Adherence to screening was defined as having had a colonoscopy within the past 10 years, a flexible sigmoidoscopy within the past 5 years, or a stool-based test within the past year. Logistic regression analyses were performed to examine the association between incarceration and adherence to screening.Results: Among the 144 men included in the final analysis, median age was 59 years (interquartile range 8 years), 84% had health insurance coverage (n= 122), and 63% (n = 92) had at least a high school diploma (Table 1). Seventy-four men (51.4%) had been incarcerated in the past, including 52 of them who had been incarcerated two or more different times. Median age at first incarceration was 18 years (interquartile range, 8 years) and the median duration of imprisonment was 48 months (interquartile range, 112 months). Fifty percent of the study population (n= 72) was adherent to CRC screening. After adjusting for age and health insurance coverage, those who had been incarcerated more than once had a significantly lower likelihood of adherence to CRC screening [0 vs >2: OR 0.46 (95% CI 0.22 – 0.97); Ptrend= 0.04] (Table 2).Discussion: Incarceration is associated with lower adherence to CRC screening in AA men. Targeted CRC-related education should be explored for AA men with a history of incarceration, and in the pre-release period for those in prisons. Further studies should assess for modifiable barriers to CRC screening in AA men with a history of incarceration.Characteristics of Study Population, by Adherence to Colorectal Cancer ScreeningAssociation between Incarceration and Adherence to Colorectal Cancer ScreeningDisclosures:Kenechukwu Chudy-Onwugaje indicated no relevant financial relationships. Sonia Abichandani indicated no relevant financial relationships. Arsheya Patel indicated no relevant financial relationships. Matthew Schliep indicated no relevant financial relationships. Raymond Cross indicated no relevant financial relationships.

P0740 (S0297). Impact of GI Fellow Participation on Polyp Resection Technique During Screening Colonoscopy 1390735 Fredy Nehme University of Missouri Impact of GI Fellow Participation on Polyp Resection Technique During Screening Colonoscopy Colorectal Cancer Prevention ePoster Session Fredy Nehme, MD1, Ahmed ElKafrawy, MD1, Harris Zamir, MD1, Daniel Merrill, MD1, Hasan Bader, MD1, Laith Al Momani, MD1, Mohammad Alomari, MD2, Tejas V. Joshi, MD3, Wendell Clarkston, MD1; 1University of Missouri, Kansas City, MO; 2East Tennessee State University, Johnson City, TN; 3LSUHSC, New Orleans, LAIntroduction: Polypectomy techniques vary widely in clinical practice and are often driven by physician preference due to the lack of standardized training. Recent evidence showed superiority of certain polypectomy techniques over others in terms of safety and rates of complete and efficient resection. Recent USMSTF guidelines recommend cold snare polypectomy for diminutive and small lesions < 1 cm while cold forceps resection should be limited to lesions ≤ 2 mm. Selection of polypectomy technique is affected by several factors. It remains unclear whether participation of GI fellows affects the polypectomy quality of colorectal lesions.We aim to investigate whether the participation of GI fellows at different stages of training affect the selection of polypectomy technique compared to screening colonoscopies performed by attendings without fellows.Methods: We performed a retrospective review of all patients who underwent a screening colonoscopy at our institution between January 2018 and June 2019. Descriptive statistics were reported as proportions. Categorical variables were compared using Chi-Square test of association with a 95% confidence interval.Results: A total of 895 colonoscopies were reviewed. From 950 polyps resected during the study period, 43.8% were performed with a GI fellow. 96.3% of diminutive polyps ≤ 2 mm and 39.7% of polyps 3-5 mm were resected using cold biopsy forceps. In addition, 51.1% of small polyps 6-9 mm were removed using a hot snare. Fellow participation lead to significantly less utilization of hot snare polypectomy for 6-9 mm polyps (55.3% vs 44.7%, p< 0.001) but significantly more use of cold forceps polypectomy for 3-9 mm polyps. Cold snare polypectomy rates were comparable between the 2 groups regardless of polyp size. More senior fellows were significantly more likely to use a cold snare for 3-9 mm polyps (p=0.004).Discussion: Adherence to recent evidence on appropriate polypectomy techniques remains suboptimal in clinical practice regardless of fellow participation. Selection of polypectomy technique by GI fellows appears to be related to endoscopy skill level given more frequent use of cold forceps polypectomy and less frequent use of hot snare polypectomy compared to GI attendings. Standardized training with adherence to USMSTF recommendations should be emphasized during fellowship training for complete and safe removal of colorectal lesions in order to optimize prevention of colorectal cancer in the future.Disclosures:Fredy Nehme indicated no relevant financial relationships. Ahmed ElKafrawy indicated no relevant financial relationships. Harris Zamir indicated no relevant financial relationships. Daniel Merrill indicated no relevant financial relationships. Hasan Bader indicated no relevant financial relationships. Laith Al Momani indicated no relevant financial relationships. Mohammad Alomari indicated no relevant financial relationships. Tejas Joshi indicated no relevant financial relationships. Wendell Clarkston indicated no relevant financial relationships.

P0750 (S0307). Increased Utilization of Split-Dose Preparation Is Associated With a Higher ADR in the Community Setting 1388863 Varun Kasula Wake Endoscopy Center Increased Utilization of Split-Dose Preparation Is Associated With a Higher ADR in the Community Setting Colorectal Cancer Prevention ePoster Session Varun Kasula, BA1, Nicole Sangha, MPH2, Manvi Kalra, MBBS3, Monica Arora, DO4, Neeraj Sachdeva, MD2; 1Wake Endoscopy Center, Cary, NC; 2Wake Endoscopy Center, Raleigh, NC; 3Kasturba Medical College, Manipal, Hisar, Haryana, India; 4Wake Endoscopy Center, Macungie, PAIntroduction: Adequate bowel preparation allowing for a good mucosal visualization is the cornerstone of a good screening colonoscopy. Traditionally, the entire preparation was given the evening before the colonoscopy. Split-dose preparation involves taking the first half the evening before the colonoscopy and the second half 4-5 hours before the scheduled procedure. The split-dose regimen is not only associated with better patient acceptability but achieves adequate preparation more often. Split-dose preparation is still not widely used in the community setting, especially by the providers who have been practicing longer and are used to giving all of the bowel-cleansing preparation the evening before the colonoscopy. This study aims to analyze the correlation between the use of split-dose preparation and the physician’s ADR.Methods: We performed a retrospective study to analyze the association between frequency of split-dose preparation utilization and ADR. We included all average-risk individuals undergoing screening colonoscopies from Jan 1, 2019, to Dec 31, 2019, at three affiliated community endoscopy centers. A total of 14 physicians performed procedures at these endoscopy centers. The frequency of a physician’s utilization of split-dose preparation was determined by independently surveying the physician's schedulers and reviewing the patient's charts. A Pearson r test was performed where 0.05 two-tailed probability was used to assess statistical significance.Results: A total of 5478 screening colonoscopies were performed during the study period with at least one adenoma detected during 2173 colonoscopies. A strong, linear correlation was found between the frequency of use of split-dose preparation and the physician’s reported ADR, r(12) = 0.83, p< .01. The mean ADR of the physicians who used the split-dose preparation by default was 1.45 standard deviations higher than the mean ADR of all of the physicians.Discussion: This retrospective analysis showed a positive correlation between adherence to the split-dose regimen and the physician’s ADR. Prior studies have shown increased ADR leads to a decreased risk of interval colorectal cancer and fatal colorectal cancer. A simple shift to increased utilization of split-dose preparation would be a cost-effective way of improving the outcome of colorectal cancer screening. More efforts should be made by practices to use split-dose preparation as much as possible.Disclosures:Varun Kasula indicated no relevant financial relationships. Nicole Sangha indicated no relevant financial relationships. Manvi Kalra indicated no relevant financial relationships. Monica Arora indicated no relevant financial relationships. Neeraj Sachdeva indicated no relevant financial relationships.

P0760 (S0317). Compliance With Colorectal Cancer Screening in Veterans After an Episode of Acute Diverticulitis: A Quality Assessment Project 1388943 Yi Jiang Rutgers New Jersey Medical School Compliance With Colorectal Cancer Screening in Veterans After an Episode of Acute Diverticulitis: A Quality Assessment Project Colorectal Cancer Prevention ePoster Session Yi Jiang, MD1, Yasaman Motlaghzadeh, MD1, Owen Deland, MD1, Thomas Ng, DO1, Christopher Lenza, DO2, Mirela Feurdean, MD1; 1Rutgers New Jersey Medical School, Newark, NJ; 2East Orange VA Hospital, East Orange, NJIntroduction: Incidence rates of acute diverticulitis (AD) have been increasing rapidly in recent decades. AD has been associated with an increased risk of colorectal cancer (CRC). The majority of guidelines recommend screening with colonoscopy after an episode. Our aim was to identify the compliance rate of colonoscopy for CRC screening, in patients presenting with an episode of AD in the East Orange Veterans Affairs Hospital (EOVA) from 10/01/2015 to 6/30/2019.Methods: We randomly selected 149 patients who were admitted to the EOVA for AD from 10/01/2015 to 6/30/2018 using ICD-10 codes. Patient’s charts were reviewed to look for computed tomography (CT) scan confirmed diverticulitis, complications (abscess, perforation, fistula, obstruction) and post-discharge follow up. Primary outcomes were the compliance rates of post-discharge follow up and colonoscopy. Secondary outcomes were the time interval between discharge and outpatient follow up, and documentation if incomplete.Results: In this study, 91% of the patients were male with a mean age of 62.8 years and BMI of 29.1kg/m2. Sixty-three percent of patients had CT scan confirmed diverticulitis, with 94% occurring in the left colon, and 85.6% occurring without complications. Of those with CT confirmed disease, 69.2% received outpatient follow up and 36.3% had colonoscopy follow up after the acute event. 33% had colonoscopy within 48 months. The mean follow-up interval was 7.4 months. For patients who did not receive colonoscopy, 18% of patients had documentation on why it was not performed, most commonly due to the patient declining.Discussion: Nearly 70% of patients who were admitted to the EOVA for CT confirmed AD had post-discharge follow up within 8 months. However, the colonoscopy compliance rate within 2 years was lower than the national average rate. The reason for non-compliance was not well documented. Further prospective studies will be needed to identify the reason for non-compliance.Disclosures:Yi Jiang indicated no relevant financial relationships. Yasaman Motlaghzadeh indicated no relevant financial relationships. Owen Deland indicated no relevant financial relationships. Thomas Ng indicated no relevant financial relationships. Christopher Lenza indicated no relevant financial relationships. Mirela Feurdean indicated no relevant financial relationships.

P0770 (S0327). Patient Perspectives and Experience With Colorectal Cancer Screening 1389409 David Johnson Eastern Virginia Medical School Patient Perspectives and Experience With Colorectal Cancer Screening Colorectal Cancer Prevention ePoster Session David A. Johnson, MD, MACG1, Kanetha Wilson, PhD2, Katie S. Lucero, MS, PhD3, John M. Maeglin, MBA4, Shari Dermer, PhD2, Doug Rex, MD, MACG5; 1Eastern Virginia Medical School, Norfolk, VA; 2Medscape Education, New York, NY; 3Medscape Education, New York City, NY; 4Medscape, LLC, Deerfield, IL; 5Indiana University Hospital, Indianapolis, INIntroduction: Compliance with colorectal cancer (CRC) screening is dependent on patient’s perceptions and care provider’s recommendations. Characterizing the patient’s decision-parameters regarding CRC screening and predictors of getting a colonoscopy has not been well studied. This study addressed both of these aspects of CRC screening from the patient perspective.Methods: WebMD conducted a consumer survey from May 14 to May 26, 2020. Data were collected anonymously via pop-up from the WebMD page. The study was exempt from institutional review board approval. Respondents were from the United States and were 50 years of age or older. They must have had a CRC screening recommended to them previously. 238 consumers responded; data were used for 233 who had complete responses. Descriptive statistics were calculated, and logistic regression examined significant predictors of getting any CRC screening or a colonoscopy. Results: 69% selected colonoscopy as their CRC screening (Table 1). 15% of participants reported that they discussed multiple options with providers, and only 36% of those got a colonoscopy (Table 2). Participants who discussed multiple tests with their providers had significantly lower odds of getting a colonoscopy (Table 3). Patients who did not discuss multiple options were over 7 times more likely to get a colonoscopy. Patients whose providers recommended a colonoscopy had significant higher odds (3 times as likely to get) of having a CRC screening performed.Discussion: Patient perception of CRC screening is weighted towards detection of cancers and polyps, yet only 69% chose colonoscopy. Notably, patient expressed desire for polyp detection paradoxically was not associated with getting colonoscopy. Although 95% selected detection of precancerous polyps or detection of both cancer and polyps as an important feature of their screening, 30% ultimately didn’t get a colonoscopy. Presenting multiple options when discussing CRC screening may inhibit patient selection of colonoscopy screening. Better understanding of patient’s perspectives for CRC screening identifies areas for patient directed education as well as care providers to direct these conversations. Limitations include the use of a convenience sample, and thereby, data represent those who use the internet to find health information at WebMD.com and are not representative of all races and ethnicities or ages over 50.Table 1. Descriptive Characteristics for Patient SampleTable 2. CRC Screening Test Selection for Those Who Discussed Multiple OptionsTable 3. Logistic Regression Results for Colonoscopy as Last CRC Screening MethodDisclosures:David Johnson: CEGX – Consultant. CRH MEDICAL – Advisory Committee/Board Member. HYGIeaCare – Advisory Committee/Board Member. ironwood – Consultant. MEDSCAPE – Advisory Committee/Board Member.Kanetha Wilson indicated no relevant financial relationships. Katie Lucero indicated no relevant financial relationships. John Maeglin indicated no relevant financial relationships. Shari Dermer indicated no relevant financial relationships. Doug Rex: Aries Pharmaceuticals – Consultant. Boston Scientific – Consultant. Medicators – Grant/Research Support. Norgine – Consultant. Olympus Corp. – Consultant, Grant/Research Support. Satisfai Health – Stockholder/Ownership Interest (excluding diversified mutual funds). Sebala Pharmaceuticals – Consultant, Grant/Research Support.

P0780 (S0337). Increased Risk of Left-Sided Advanced Colorectal Neoplasia but Not Serrated Polyps in Adults Less Than 50 Years Who Present With Bleeding: Data From the New Hampshire Colonoscopy Registry 1389762 Joseph Anderson Dartmouth College Geisel School of Medicine Increased Risk of Left-Sided Advanced Colorectal Neoplasia but Not Serrated Polyps in Adults Less Than 50 Years Who Present With Bleeding: Data From the New Hampshire Colonoscopy Registry Colorectal Cancer Prevention ePoster Session Joseph C. Anderson, MD1, Christina Robinson, MS1, Lynn F. Butterly, MD2; 1Dartmouth College Geisel School of Medicine, Hanover, NH; 2Dartmouth College Geisel School of Medicine, Lebanon, NHIntroduction: Data regarding advanced neoplasia and serrated polyps (SPs) in adults < 50 years of age who present with bleeding are vital for screening and diagnosing CRC in adults < 50. We used data from the New Hampshire Colonoscopy Registry (NHCR) to compare the anatomical location of advanced neoplasia and SPs in average risk patients to those who present with bleeding.Methods: An average risk screening equivalent cohort was created for the analysis. Since many adults < 50 have diagnostic exams, we formed an “average risk” sample by selecting diagnostic exams with indications that are associated with a low risk for advanced neoplasia such as change in bowel habits (e.g. constipation) and abdominal pain (Cha et al GIE 2015) and combining these with screening exams. We excluded higher risk indications from this cohort (e.g. anemia or bleeding) as well as surveillance, family history of first degree relative with CRC, IBD, incomplete exams, and poor bowel prep. We compared outcomes for the average risk equivalent group to our group of interest, i.e., exams with bleeding indications. Outcomes were advanced neoplasia (adenomas >1cm, with villous elements, HGD, and CRC) and clinically important SPs ((HP >1 cm), any sessile serrated polyp and traditional serrated adenomas) as stratified by anatomical location, left sided (distal to splenic flexure) and right sided (proximal to descending colon). We present absolute and adjusted risks for advanced neoplasia and SPs. Covariates were age, sex, smoking and BMI.Results: There were 5855 NHCR average risk patients < 50 years (avg age 38.5 yrs) and 2814 with bleeding (37.6 yrs). The absolute and adjusted risks for left sided advanced neoplasia were significantly higher for patients with bleeding than those in the average risk equivalent group (OR=1.73 95% CI: 1.28-2.34) (Table 1). The increased risk was especially high for left sided CRC (OR=4.82 95% CI 1.47-15.81). Conversely there was no increased risk for right sided advanced neoplasia, CRC or proximal or distal SPs.Discussion: Young patients with bleeding had an increased risk for left sided advanced neoplasia. These data support current recommendations that patients < 50 with bleeding should undergo evaluation for colorectal neoplasia, especially of the left side of the colon. However, there was no increased risk for SPs or right sided neoplasia or CRC in young individuals with bleeding, highlighting a clinically relevant difference in outcomes that may affect choice of testing options for this group.As compared to the average risk screening equivalent group, there was an increased risk for left sided neoplasia including CRC but not for right sided neoplasia or serrated polyps at any location.Disclosures:Joseph Anderson indicated no relevant financial relationships. Christina Robinson indicated no relevant financial relationships. Lynn Butterly indicated no relevant financial relationships.

P0830 (S0356). A Tertiary Esophageal Center’s Experience With EsoFLIP 1389268 Anh Nguyen Baylor University Medical Center and Center for Esophageal Research, Baylor Scott & White Research Institute A Tertiary Esophageal Center’s Experience With EsoFLIP Esophagus ePoster Session Jesse Zhang, BS1, Anh D. Nguyen, MD2, Roseann Mendoza, FNP1, Eitan Podgaetz, MD, MPH3, Rhonda F. Souza, MD2, Stuart J. Spechler, MD, FACG2, Vani Konda, MD, FACG2; 1Center for Esophageal Diseases, Baylor University Medical Center, Dallas, TX; 2Baylor University Medical Center and Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, TX; 3Center for Thoracic Surgery, Center for Esophageal Diseases, Baylor University Medical Center and Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, TXIntroduction: EsoFLIP is a novel technique for esophageal balloon dilation that uses impedance planimetry technology to provide real-time display of the diameter of the esophageal segment during dilation. The EsoFLIP balloon can reach a diameter of 30 mm, similar to pneumatic dilation balloons traditionally used to treat achalasia, but without the need for fluoroscopic positioning. We report our center’s experience with EsoFLIP for esophageal dilation.Methods: We performed a retrospective review of our center’s database to identify all patients who had esophageal dilation performed with the EsoFLIP balloon. Data were collected on patient clinical characteristics and symptom response. For achalasia treatment, a post dilation EGJ diameter of 16 mm at a 30 mL balloon fill volume was considered a technical success.Results: 46 patients (mean age 61 years, 18 male) had EsoFLIP dilations between December 2018 and February 2020. There were 26 surgery-naïve patients; 5 had achalasia (2 Type 2, 3 Type 3), 13 had EGJOO, and 8 had achalasia-like disorders with normal IRP but a low EGJ distensibility index by EndoFLIP. At the first follow-up visit, 20 of the 26 surgery-naïve patients (77%) reported symptomatic improvement with Eckardt scores falling from a mean of 5 to 2. Technical success was achieved in 20 of the 26 patients (77%) while the remaining patients had stepwise dilation due to patient preference or clinical judgement. Of those who had technical success, 15 of the 20 (75%) reported symptomatic improvement. There were 12 patients who had prior myotomy for achalasia (10 Heller myotomy with Dor fundoplication, 2 POEM); symptomatic improvement was reported by 8 patients (67%). There were 8 patients with dysphagia after anti-reflux surgery (4 Nissen fundoplication, 2 Dor fundoplication, 1 Toupet fundoplication, 1 Angelchik prosthesis); symptomatic improvement was reported by 5 patients (62%). Among all 46 patients, there was 1 perforation (2%) in a patient who had prior botulinum injection; the perforation was identified immediately and managed successfully with a stent.Discussion: EsoFLIP improved symptoms in approximately three-quarters of surgery-naïve patients and in two-thirds of patients with prior foregut surgery. The perforation rate (2%) was similar to that for pneumatic dilation. The ability to perform stepwise dilation and lack of need for fluoroscopy are advantages of EsoFLIP. Additional studies are needed to determine how it may be utilized as a stepwise approach in these patients. Disclosures:Jesse Zhang indicated no relevant financial relationships. Anh Nguyen indicated no relevant financial relationships. Roseann Mendoza indicated no relevant financial relationships. Eitan Podgaetz indicated no relevant financial relationships. Rhonda Souza indicated no relevant financial relationships. Stuart Spechler: Interpace Diagnostics – Consultant. Ironwood Pharmaceuticals – Consultant. Phathom Pharmaceuticals – Consultant. UpToDate – Other Financial or Material Support, Topic author.Vani Konda indicated no relevant financial relationships.

P0840 (S0366). Assessment of Emergency Department Visits, Hospital Admission Trends, and Financial Burden of Eosinophilic Esophagitis: A National Inpatient Sample Database Study 1390597 Muhammad Hashim Hayat Vanderbilt University Medical Center Assessment of Emergency Department Visits, Hospital Admission Trends, and Financial Burden of Eosinophilic Esophagitis: A National Inpatient Sample Database Study Esophagus ePoster Session Muhammad Hashim Hayat, MBBS, Kevin G. Buell, MBBS, Rishi D. Naik, MD, MS, Michael F. Vaezi, MD, PhD, MS, FACG, Dhyanesh A. Patel, MD, MS; Vanderbilt University Medical Center, Nashville, TNIntroduction: In the last two decades, Eosinophilic esophagitis (EoE) has emerged as a dominant cause of dysphagia in adults. The incidence and prevalence of EoE is rising and the prevalence in adults is currently estimated between 40 to 90 cases per 100,000 people. Clinicopathological guidelines relating to EoE were first published in 2007 which led to increased recognition of the disease as well as diagnosis. We assessed the impact of these changes on the total number of hospital admissions trends and healthcare expenditure by reviewing the nationwide EoE related admissions in the United States over the past eight years.Methods: We reviewed the National Inpatient Sample Database for Emergency Department (ED) Visits and all hospitalizations with a principal discharge diagnosis of EoE (ICD9 code 530.13) between the years 2008–2015. The year 2008 as a start point due to the first consensus clinicopathological diagnostic guidelines for the diagnosis of EoE by the American Gastroenterological Association being published in 2007. 2015 was decided as an endpoint as data for 2016 and beyond is still not fully available. Trends in discharge rates, costs of hospitalization, and length of stay were analyzed.Results: In 2008, the total number of age-sex standardized admissions for EoE was 140 and the total number of ED visits was 178. In 2014, these figures increased to 705 and 1260, respectively. Rate of admissions per 100,000 patients increased from 0.046 in 2008 to 0.249 (p < 0.01) in 2015, a 441.3% increase from baseline. The rate of ED visit per 100,000 patients increased from 0.058 in 2008 to 0.395 in 2014, a 581% increase from baseline. The mean length of stay for admissions increased from 2.59 days in 2008 to 3.57 days in 2015 (p < 0.01). The mean hospital cost associated with EoE admission doubled from $15,775 in 2008 to $30,514 in 2015, after adjusting for inflation.Discussion: The incidence of patients admitted for EoE in the United States and the length of hospital stay significantly increased from 2008 to 2015. Whether this was due to increased recognition or increase in incidence, remains unclear. The cost of hospitalization equally doubled. These trends reflect the improvement in our diagnostic testing for EoE and the need for better treatment and symptom control.Figure 1: National Diagnoses - ICD-9-CM Code Principal Diagnosis: 530.13, Eosinophilic Esophagitis - All ED VisitsFigure 2: National Diagnoses - ICD-9-CM Code Principal Diagnosis: 530.13, Eosinophilic Esophilic - All Admissions with Standard ErrorsFigure 1: National Diagnoses - ICD-9-CM Code Principal Diagnosis: 530.13, Eosinophilic Esophagitis - Charges Per AdmissionDisclosures:Muhammad Hashim Hayat indicated no relevant financial relationships. Kevin Buell indicated no relevant financial relationships. Rishi Naik indicated no relevant financial relationships. Michael Vaezi indicated no relevant financial relationships. Dhyanesh Patel indicated no relevant financial relationships.

P0850 (S0376). Clinical Characteristics and Outcome of Oral Mucositis Associated With Immune Checkpoint Inhibitors in Patients With Cancer 1389742 Jake Jacob Baylor College of Medicine Clinical Characteristics and Outcome of Oral Mucositis Associated With Immune Checkpoint Inhibitors in Patients With Cancer Esophagus ePoster Session Jake Jacob, MD1, Barbara E. Dutra, MD2, Victor Garcia-Rodriguez, MD2, Kavea Panneerselvam, MD1, Fiyinfoluwa O. Abraham, MD2, Fangwen Zou, MD3, Petros Grivas, MD, PhD4, John Thompson, MD4, Anusha Shirwaikar Thomas, MD5, Yinghong Wang, MD, PhD5; 1Baylor College of Medicine, Houston, TX; 2University of Texas Health Science Center, Houston, TX; 3University of Texas MD Anderson Cancer Center, Houton, TX; 4University of Washington, Seattle, WA; 5University of Texas MD Anderson Cancer Center, Houston, TXIntroduction: Increased use of immune checkpoint inhibitors (ICI) for cancer therapy has led to a rise in immune-related adverse events (irAEs), including toxicity of the gastrointestinal tract. Mucositis is one such irAE for which there is limited data. This study aims to evaluate the clinical characteristics, disease course, treatment, and outcome of ICI-related mucositis.Methods: This is a retrospective, single center study of 152 adult patients (pts) who received ICI therapy and developed oral mucositis at MD Anderson Cancer Center from January 2009 to September 2019. ICD 9 and10 codes for mucositis and/or stomatitis were used to identify eligible pts. Baseline, demographic and oncology related data were collected. Statistical analysis to determine the association between measured variables and overall survival was performed using RStudio (v 1.0.136) and SPSS24.Results: In our cohort of 152 patients, the mean age was 60 (±14) years and 51% were men. The most common cancer type was melanoma (28%), with 73% having stage IV disease. The median time to onset of mucositis from ICI initiation was 97 days; 33 (22%) received CTLA-4 monotherapy or combination with PD-1/L1, and 119 (78%) received PD-1/L1 monotherapy. Anti-CTLA-4 based therapy was more frequently associated with earlier onset of mucositis (72 vs 96 days, p=0.077), lower rate of symptom resolution (18% vs 40%, p=0.032) compared to PD-1/L1 monotherapy. The most common clinical presentation of mucositis was odynophagia and/or oral pain (90%). Most patients (91%) developed CTCAE grade 1-2 mucositis; of the 36 (25%) patients that required immunosuppression, we note the presence of a longer symptom duration (84 vs 34 days, p=0.002) and higher recurrence rate (61% vs 32%, p=0.006) compared to those patients not needing immunosuppression (Table 2). Interruption of ICI treatment was associated with shorter overall survival (OS)(p=0.037) compared to continued ICI treatment through mucositis. Mucositis recurrence, immunosuppressant use, and presence of other irAEs were not associated with OS.Discussion: Mucositis associated with ICI has not been well recognized and is under-studied. The diagnosis requires the exclusion of other common etiologies related to cancer treatment. Clinical symptoms are mostly mild, however up to 25% in our cohort required immunosuppressant therapy. Mucositis recurrence can be up to 38%. Interruption of ICI treatment is associated with shorter OS.Table 1. Clinical characteristics of mucositis based on the type of ICI therapy (N=152). Abbreviations: ICI, immune checkpoint inhibitor; IQR, interquartile range; SD, standard deviation. CTLA-4containing therapy included CTLA-4 monotherapy (16 cases) and combination of CTLA-4 and PD-1/L1 agents (17 cases).Table 2. Clinical characteristics and outcomes of mucositis stratified by Immunosuppressant treatment (N=152). 22 patients used systemic immunosuppressants only, 7 used topical only, and 7 used both topical and systemic immunosuppressants. Agents include: IV Methylprednisolone, PO Dexamethasone, PO Prednisone, Topical Dexamethasone, topical fluocinonideFigure 1. Overall Survival in association with immune checkpoint inhibitor termination(A) and recurrence of mucositis (B)Disclosures:Jake Jacob indicated no relevant financial relationships. Barbara Dutra indicated no relevant financial relationships. Victor Garcia-Rodriguez indicated no relevant financial relationships. Kavea Panneerselvam indicated no relevant financial relationships. Fiyinfoluwa Abraham indicated no relevant financial relationships. Fangwen Zou indicated no relevant financial relationships. Petros Grivas indicated no relevant financial relationships. John Thompson indicated no relevant financial relationships. Anusha Shirwaikar Thomas indicated no relevant financial relationships. Yinghong Wang indicated no relevant financial relationships.

P0860 (S0386). Newly Diagnosed Barrett’s Esophagus After Bariatric Surgery 1390267 Abbinaya Elangovan MetroHealth Medical Center/Case Western Reserve University School of Medicine Newly Diagnosed Barrett’s Esophagus After Bariatric Surgery Esophagus ePoster Session Abbinaya Elangovan, MD1, Fahmi Shibli, MD2, Ronnie Fass, MD, FACG2; 1MetroHealth Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH; 2MetroHealth Medical Center, Case Western Reserve University, Cleveland, OHIntroduction: Bariatric surgery can affect esophageal motility and lower esophageal sphincter competence. Laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) have been shown to worsen or lead to the emergence of GERD. However, there is limited evidence on the role of these bariatric procedures in the development of newly diagnosed Barrett’s esophagus (BE). Hence, we aimed to study the occurrence of newly diagnosed BE following bariatric surgery in individuals without a history of GERD pre-operatively.Methods: Explorys, an electronic health record-based database was used for the current analysis. Individuals with BMI ≥ 30 kg/m2 who underwent LSG or LAGB, from 2010 to 2019 were reviewed. For comparison, patients who underwent the bariatric procedure, Roux-en-Y gastric bypass (RYGB), known to reduce GERD, were also included. Individuals with malignancy of stomach and pancreas, gastroparesis, or any systemic disorder known to induce GERD were excluded. Using the temporal feature of Explorys, we excluded individuals with a pre-operative history of GERD. To identify individuals with post-surgical follow-up, those who underwent esophagogastroduodenoscopy (EGD) 180 days after surgery were included. Individuals were considered to have newly diagnosed BE following bariatric surgery when they have a ‘first-ever’ diagnosis of BE after 180 days of surgery. Among those with newly diagnosed BE, demographics, and the use of proton pump inhibitors (PPI) were analyzed using univariate analyses.Results: In our study, 3,300, 11,520 and 1,890 individuals underwent RYGB, LSG, and LAGB, respectively, between 2010 and 2019. Of those, 450, 940, and 400 individuals underwent EGD following RYGB, LSG, and LAGB respectively. The percentage of newly diagnosed BE was significantly higher after LSG (4.3%) compared to RYGB (2.1%), p =0.042. Similarly, BE was significantly higher after LAGB (5.0%) compared to RYGB, p = 0.021. A relatively higher percentage of individuals with newly diagnosed BE were started on PPI following LAGB (50%) compared to LSG (25%), p = 0.05. Age ≥ 50 years and men were more likely to demonstrate newly diagnosed BE following LSG (Table 1).Discussion: This is the first study to show higher rates of newly diagnosed BE following LSG and LAGB as compared with RYGB. Thus, individuals undergoing restrictive bariatric surgeries are more likely to develop severe GERD and consequently complications such as BE.Table 1Disclosures:Abbinaya Elangovan indicated no relevant financial relationships. Fahmi Shibli indicated no relevant financial relationships. Ronnie Fass indicated no relevant financial relationships.

P0870 (S0396). Helicobacter pylori and Esophageal Cancer: A Systematic Review and Meta-Analysis 1390555 Katia El Jurdi University of Kansas School of Medicine Helicobacter pylori and Esophageal Cancer: A Systematic Review and Meta-Analysis Esophagus ePoster Session Award: Presidential Poster AwardKatia El Jurdi, MD1, Sachin Srinivasan, MD1, Yasmine Hussein Agha, MD2, Ali Taleb, MD1, Chelsea Wuthnow, MD1, Saritha Gorantla, MD1, William R. Kilgore, MD1, Nathan Tofteland, MD1, William J. Salyers, MD1; 1University of Kansas School of Medicine, Wichita, KS; 2University of Kansas, School of Medicine, Wichita, KSIntroduction: Esophageal cancer (EsoCa) is the 9th most common cancer and the 6th most common cause of cancer deaths worldwide. Helicobacter pylori (H. pylori) has been shown to play a role in gastric cancer, but its relationship to EsoCa remains controversial. The aim of this meta-analysis is to determine whether an association exists between H. pylori and the subsequent development of EsoCa.Methods: We performed an electronic search of PubMed, Embase, Web of Science, and Cochrane databases for studies that reported data on EsoCa occurrences and H. pylori status from inception to April 1, 2020. Case reports/series, editorials and review articles were excluded. Primary outcomes included pooled weighted incidence of EsoCa in H. pylori positive (HP+) and negative (HP-) groups and the pooled odds of cancer occurrence in HP+ compared to HP- groups. We also performed subgroup analysis for studies by geographical location (Western vs. Asian studies) and meta-regression for the primary outcome based on age and duration of follow-up. Meta-analysis outcomes, heterogeneity (I2), meta-regression (for effect of covariates) and publication bias (Rucker’s test) were derived by statistical software R and Open meta-analyst.Results: Our initial search resulted in 1,624 articles, all of which were screened by two independent reviewers. A total of 23 studies with 39,932 patients [mean age 58 ± 4.9 years, mean follow-up duration of 75 months (range 12-216 months)] were included for analysis. Pooled incidence of EsoCa in the HP+ group was 9.8% (95%CI 8.8-10.9) and in the HP- group was 22% (95%CI 20.1-24.0). Odds of EsoCa was significantly lower in the HP+ group compared to that of the HP-group (OR 0.69; 95%CI 0.58-0.82; I2=79%). Subgroup analysis with 17 Western studies (OR 0.68; 95%CI 0.55-0.85; I2=78%) and 6 Asian studies (OR 0.71; 95%CI 0.50-1.00; I2=84%) showed that the odds of EsoCa was consistently lower in the HP+ group compared to the HP- group. Meta-regression did not demonstrate any significance of age (p=0.11) or duration of follow-up (0.44) to the incidence of EsoCa. There was no significant publication bias (Rucker’s coefficient for funnel plot asymmetry=0.07).Discussion: The presence of H. pylori appears to exert a protective effect against the development of EsoCa. This may have implications on decisions to treat in certain high-risk populations. Randomized controlled trials are needed to better characterize the effects of H. pylori and the potential consequences of its eradication on EsoCa development.Figure 1. Forest plot of H. pylori and risk of esophageal cancer.Figure 2. Meta-regression analysis of age to incidence of esophageal cancer.Figure 3. Meta-regression analysis of study duration to the incidence of esophageal cancer.Disclosures:Katia El Jurdi indicated no relevant financial relationships. Sachin Srinivasan indicated no relevant financial relationships. Yasmine Hussein Agha indicated no relevant financial relationships. Ali Taleb indicated no relevant financial relationships. Chelsea Wuthnow indicated no relevant financial relationships. Saritha Gorantla indicated no relevant financial relationships. William Kilgore indicated no relevant financial relationships. Nathan Tofteland indicated no relevant financial relationships. William Salyers indicated no relevant financial relationships.

P0880 (S0406). Predictors of Gastroesophageal Reflux Disease Post-Lung Transplant 1388399 John Blackett Columbia University Medical Center Predictors of Gastroesophageal Reflux Disease Post-Lung Transplant Esophagus ePoster Session John W. Blackett, MD1, Luke Benvenuto, MD2, Selim Arcasoy, MD1, Daniela Jodorkovsky, MD1; 1Columbia University Medical Center, New York, NY; 2Columbia University Medical Center, New York City, NYIntroduction: Gastroesophageal reflux disease (GERD) can be a pre-existing condition in chronic lung disease but some patients are diagnosed with GERD following lung transplantation. GERD is known to be associated with worse transplant outcomes including development of bronchiolitis obliterans syndrome. The predictors of post-transplant de-novo GERD are unknown. This study sought to identify risk factors for the diagnosis of GERD post-lung transplant.Methods: This was a retrospective cohort study of adult patients who underwent lung transplant at Columbia University Medical Center between January 2008 and December 2018. The primary outcome was diagnosis of GERD within 3 years post-transplant, defined as a positive reflux test with elevated total percent acid exposure [ >6%], DeMeester score >14.7, or endoscopic evaluation showing erosive esophagitis. Relevant covariates including age, race, transplant type, body mass index (BMI), transplant diagnosis group, and medical comorbidities were evaluated as predictors of GERD in a multivariable logistic regression model. Results: Of 605 patients without abnormal pre-operative testing, 146 (24.1%) had positive pH reflux testing or erosive esophagitis within 3 years following transplant. Patients with post-transplant GERD had higher rates of post-transplant gastroparesis (29%) compared to those without GERD (17%, p< 0.01). On multivariable logistic regression, sex, age, history of diabetes, type of transplant, diagnosis group, renal function, body mass index, and surgeon were not significantly predictive of GERD post lung-transplant. There was a trend towards lower risk of GERD in black patients relative to white patients (OR 0.50, p=0.058), and a higher risk of GERD in cystic fibrosis patients relative to obstructive lung disease (OR 1.80, p=0.18), but this did not meet statistical significance.Discussion: GERD is common both before and after lung transplantation. However, in our study, we did not find a significant predictor of who develops GERD post-transplant. Transplant type, BMI, renal function, race, age, indication, and surgeon were not significantly associated with the development of GERD based on objective testing. As it remains unlikely to accurately predict which patients will develop GERD post-transplant, all patients should be routinely screened for symptoms and early testing pursued.Disclosures:John Blackett indicated no relevant financial relationships. Luke Benvenuto indicated no relevant financial relationships. Selim Arcasoy indicated no relevant financial relationships. Daniela Jodorkovsky indicated no relevant financial relationships.

P0890 (S0416). Is Mallory-Weiss Syndrome Associated With Hiatal Hernia? 1388446 Arnold Forlemu Creighton University School of Medicine Is Mallory-Weiss Syndrome Associated With Hiatal Hernia? Esophagus ePoster Session Arnold Forlemu, MD1, Mays Almohammedawi, MBChB2, Ali Alshati, MD1, Dimas Kosa, MD1, Raissa Nana Sede Mbakop, MD3, Zaid Ansari, MD4, Toufic Kachaamy, MD5; 1Creighton University School of Medicine, Phoenix, AZ; 2Baghdad University College of Medicine, Phoenix, AZ; 3University of Yaoundé I, Phoenix, AZ; 4St. Joseph's Hospital and Medical Center, Creighton University School of Medicine, Phoenix, AZ; 5Cancer Treatment Centers of America, Phoenix, AZIntroduction: Mallory Weiss Syndrome (MWS) has an incidence rate of up to 15% among patients presenting with upper gastrointestinal bleeding. It has been proposed that retching increases the potential for mucosal laceration by creating a higher-pressure gradient in the hiatus hernia (HH) as compared with the rest of the stomach. In this abstract, we aimed at determining the association between MWS and HH, before and after HH repair.Methods: We used the 2009 to 2014 nationwide inpatient sample database (NIS) for this study. NIS is the largest publicly available all‐payer inpatient database in the United States with more than seven million hospital stays each year, as a part of the Healthcare Cost and Utilization Project (HCUP). International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for WMS, unrepaired HH, and repaired HH, were obtained (appendix 1). Logistic regression was used to model the association between MWS and HH before and after repair. Participants included in this study were aged 18 and above.Results: We identified 38,036 patients with MWS. The mean age of MWS diagnosis was 56 years. The male to female ratio was 1.6:1. Most of the patients were white (65.2%), had Medicare insurance (43.6%), and were from urban, non-teaching hospitals (85.1%). There was a significant association between MWS and HH before and after repair (p< 0.001). Using logistic regression, HH is significantly and positively associated with MWS, while repaired HH has a statistically significant negative association with MWS, independent of age, sex, and race (Table 1).Discussion: The pathogenesis of MWS is not completely understood. HH was reported in up to 80% of patients with MWS in case series, however, one study involved 2342 concluded no significant association between MWS and HH. In this study, we found a significantly high prevalence of MWS in patients with unrepaired HH. Compared to unrepaired HH, repaired HH was associated with a significantly lower MWS prevalence. This difference in MWS prevalence between repaired and unrepaired HH populations suggests HH as a potential risk factor for MWS. Further prospective research is needed to illustrate this relationship.Table 1: Factors associated with Mallory Weiss syndromeAppendixDisclosures:Arnold Forlemu indicated no relevant financial relationships. Mays Almohammedawi indicated no relevant financial relationships. Ali Alshati indicated no relevant financial relationships. Dimas Kosa indicated no relevant financial relationships. Raissa Nana Sede Mbakop indicated no relevant financial relationships. Zaid Ansari indicated no relevant financial relationships. Toufic Kachaamy indicated no relevant financial relationships.

P0900 (S0426). Evaluation of Manometric Parameters in Patients With Asthma: A Novel Study Using High-Resolution Esophageal Manometry 1387853 Alfred Nelson Mayo Clinic Evaluation of Manometric Parameters in Patients With Asthma: A Novel Study Using High-Resolution Esophageal Manometry Esophagus ePoster Session Marilia Montenegro, MD, Monia Werlang, MD, Alfred D. Nelson, MBBS, Brian E. Lacy, MD, PhD, FACG; Mayo Clinic, Jacksonville, FLIntroduction: Asthma and gastroesophageal reflux (GERD) are two closely related conditions. Asthma can be an extra-intestinal manifestation of GERD; GERD can be a trigger for asthma. Conventional solid state manometry showed that esophageal dysfunction is common in asthmatic patients even without typical GERD symptoms. Ineffective esophageal motility (IEM) and hypotonic lower esophageal sphincter (LES) were the most common abnormalities previously reported, the latter being associated with the use of inhaled medications such as albuterol. There are no published data evaluating asthmatic patients using High Resolution Esophageal Manometry (HREM) and the v.3 Chicago classification.Methods: Single-center, retrospective review of HREM studies from January 1, 2015 to December 31, 2019 performed in asthmatic patients. HREM was performed using a standardized protocol and catheter (36 circumferential sensors spaced 1cm apart; 18 impedance channels O.D. 4.2mm; Sierra Scientific Instruments, Given Imaging). The v.3 Chicago Classification was used for study interpretation.Results: This study included 151 patients (Table 1). Typical GERD symptoms were present in 78 (51.6%) patients; 95 (62.9%) patients had manometric abnormalities. The most common findings were esophagogastric junction outflow obstruction in 35 (23.2%) patients, and IEM in 33 (21.9%) patients (Table 2). Mean values of LES length, LES resting pressure, upper esophageal sphincter resting pressure, and integrated relaxation pressure were within normal limits (Table 3). Ninety (59.6%) patients were using albuterol inhalers, this did not significantly change HREM findings (p >.05) (Table 3). Eighty eight patients also underwent pH-testing (24-hour impedance-pH or 48-hour BRAVO test) with a mean (standard deviation) DeMeester score of 17.72 (26.44).Discussion: This novel study using HREM found multiple manometric abnormalities according to the v.3 Chicago classification among patients with asthma, contrary to prior studies using solid state catheters that showed predominantly a prevalence of IEM. In contrast to prior solid state studies, hypotensive LES was not a common finding. Prospective studies evaluating a larger population should be done to further delineate patterns of manometric abnormalities and their impact on asthma care, and to determine the utility of HREM in this population. Previous findings of albuterol-induced esophageal dysmotility were not confirmed in this study.Table 1Table 2Table 3Disclosures:Marilia Montenegro indicated no relevant financial relationships. Monia Werlang indicated no relevant financial relationships. Alfred Nelson indicated no relevant financial relationships. Brian Lacy indicated no relevant financial relationships.

P0910 (S0436). Pre-Transplant GERD Does Not Predict Post-Lung Transplant Mortality, Acute Rejection, or Chronic Rejection: A 10-Year Retrospective Review 1389631 Matthew Meyers Vanderbilt University Medical Center Pre-Transplant GERD Does Not Predict Post-Lung Transplant Mortality, Acute Rejection, or Chronic Rejection: A 10-Year Retrospective Review Esophagus ePoster Session Matthew H. Meyers, MD, Muhammad Hashim Hayat, MBBS, Claudio R. Tombazzi, MD, Chris Slaughter, PhD, Tina Higginotham, MPA, Dhyanesh A. Patel, MD, MS, Michael F. Vaezi, MD, PhD, MS, FACG, Rishi D. Naik, MD, MS; Vanderbilt University Medical Center, Nashville, TNIntroduction: Introduction: The long-term impact of GERD on morbidity and mortality in lung transplant are still unclear. Conflicting evidence exists regarding the importance of pre-transplant GERD and lung transplant outcomes. We had previously found an association between a pre-transplant diagnosis of GERD based on symptoms and increased lung transplant mortality. We therefore hypothesized that pre-transplant GERD as measured by endoscopy and pH criteria is a predictor of mortality and acute and chronic rejection in lung transplant patients.Methods: Methods: In a single-center retrospective 10-year cohort study, we analyzed all patients who underwent lung transplantation from 2009-2019. Time-to-event analysis using Cox proportional hazards model was utilized for mortality, acute rejection by biopsy, and the development of chronic lung allograft dysfunction (CLAD), testing pre-transplant GERD as a predictor for the above adjusted for age, gender, BMI, and transplant status (single vs. double lung). Pre-transplant GERD was defined based on DeMeester score, evidence of Barrett’s esophagus, peptic strictures, or esophagitis. Results: Results: 227 patients who underwent lung transplantation (30% IPF, 26% COPD, 19% CF) were analyzed in this study. 72 patients underwent pre-transplant reflux testing. 55.8% (n=39) of those tested met our criteria for GERD. Among all patients, 28.2% (n=64) experienced the outcome of death. 62.5% (n=15) had a pre-transplant diagnosis of GERD among those who died and who underwent pre-transplant testing. In a time to event analysis, GERD was not found to be predictive of time to death, time to acute rejection by biopsy (not shown), or time to the development of CLAD (Figure 1 and 2). GERD was negatively predicted by the presence of gastroparesis with 8 patients in the non-GERD group having gastroparesis compared to 0 in the GERD group (Table 1).Discussion: Discussion: In a 10-year single-center retrospective follow-up study, no association was found between a pre-transplant diagnosis of GERD based on testing and lung transplant mortality, acute rejection, or CLAD. One potential predictive variable of death and rejection, independent of GERD, was gastroparesis. Overall, early identification and management of GERD as per our routine practice shows that pre-transplant GERD diagnosis does not worsen post-transplant outcomes. Prospective studies on dose of acid suppression, timing of anti-reflux surgeries, and uniform standards of pre-transplant evaluation are needed. Table 1. Patient Characteristics by GERDFigure 1. GERD as a Risk Factor for MortalityFigure 2. GERD as a Risk Factor for CLADDisclosures:Matthew Meyers indicated no relevant financial relationships. Muhammad Hashim Hayat indicated no relevant financial relationships. Claudio Tombazzi indicated no relevant financial relationships. Chris Slaughter indicated no relevant financial relationships. Tina Higginotham indicated no relevant financial relationships. Dhyanesh Patel indicated no relevant financial relationships. Michael Vaezi indicated no relevant financial relationships. Rishi Naik indicated no relevant financial relationships.

P1100 (S0463). Economic Costs Associated With Reduction in Work Productivity Loss for Ulcerative Colitis Patients Receiving Ustekinumab Using Results From the UNIFI Clinical Trial 1388790 Amanda Teeple Janssen Scientific Affairs, LLC Economic Costs Associated With Reduction in Work Productivity Loss for Ulcerative Colitis Patients Receiving Ustekinumab Using Results From the UNIFI Clinical Trial Functional Bowel Disease ePoster Session Claudia Carlucci, MSc1, Béranger Lueza, PhD2, Astrid Foix Colonier, MSc2, Zahra Kamal, MSc3, Erik Muser, PharmD, MPH4, Dominik Naessens, PhD5, Amanda Teeple4; 1Amaris, Health Economics and Market Access, UK, London, England, United Kingdom; 2Amaris, Health Economics and Market Access, France, Paris, Ile-de-France, France; 3Amaris, Health Economics and Market Access, Canada, Toronto, ON, Canada; 4Janssen Scientific Affairs, LLC, Horsham, PA; 5Janssen Pharmaceutica NV, Beerse, Antwerpen, BelgiumIntroduction: The economic burden associated with work productivity loss is substantial in patients with ulcerative colitis (UC). The objective of this study was to determine the indirect costs in US dollars associated with changes in work productivity loss (WPL) for UC patients treated with ustekinumab (UST) over a year.Methods: The Work Productivity and Activity Impairment (WPAI) questionnaire completed by patients in the UNIFI trial was used to assess the average percentage of work time missed (absenteeism) and impairment while at work (presenteeism) due to UC. Absenteeism costs per year were calculated as the product of an annual salary and percentage of work time missed, whereas presenteeism costs were calculated as the product of an annual salary, work time not missed and percentage of productivity impairment. The total cost per patient associated with WPL (absenteeism + presenteeism) was assessed at baseline and after 1 year of treatment with ustekinumab using an annual salary of $54,906, as reported by the Bureau of Labor Statistics and the Census Bureau in 2018.Results: The analysis included 206 UC patients from the UNIFI trial treated with UST 6mg/kg at induction followed by 90mg taken every 8 or 12 weeks at maintenance (UST 6-UST 90 Q8W/Q12W). Of these, 137 were treated with UST 6-UST 90 Q8W. The average total costs for a UC patient at baseline by arm were $30,716 (UST 6-UST 90 Q8W/Q12W) and $30,697 (UST 6-UST 90 SC Q8W). The average absenteeism, presenteeism and total WPL costs at baseline and week 52 are reported in Figure 1. Treatment with UST 6-UST 90 Q8W/Q12W over 1 year resulted in an estimated reduction of $17,314 in WPL costs per patient (absenteeism: $6,040; presenteeism: $11,274). A similar reduction was estimated for UST 6-UST 90 Q8W treated patients (total per patient: $15,673; absenteeism: $4,887; presenteeism: $10,786). Presenteeism accounted for 65% and 69% of the total WPL costs reduction in patients receiving UST 6-UST 90 Q8W/Q12W and UST 6-UST 90 Q8W, respectively.Discussion: UC patients treated with ustekinumab over a year experienced a reduced absenteeism and impairment while at work, which was associated with savings in WPL costs. The estimated cost reductions after 1 year of treatment with ustekinumab were over $15,000 per patient for the treatment groups assessed. The largest cost reductions were found in presenteeism compared to absenteeism.Absenteeism, presenteeism and total WPL costs in USD estimated at baseline and week 52 for patients who received ustekinumabDisclosures:Claudia Carlucci indicated no relevant financial relationships. Béranger Lueza indicated no relevant financial relationships. Astrid Foix Colonier indicated no relevant financial relationships. Zahra Kamal indicated no relevant financial relationships. Erik Muser: Janssen Scientific Affairs, LLC – Employee. Johnson & Johnson – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Dominik Naessens: Johnson & Johnson – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Amanda Teeple: Janssen Scientific Affairs LLC – Employee. Johnson & Johnson – Stockholder/Ownership Interest (excluding diversified mutual funds).

P1110 (S0473). Domperidone Is Superior Compared With Metoclopramide in Improving Gastroparesis Symptoms: A Systematic Review and Meta-Analysis 1389043 Gian Galura Texas Tech University Health Sciences Center Domperidone Is Superior Compared With Metoclopramide in Improving Gastroparesis Symptoms: A Systematic Review and Meta-Analysis Functional Bowel Disease ePoster Session Gian Galura, MD1, Chelsey Bravenec, MD1, Kanchana Myneedu, MD1, Reza Hejazi, MD2, Irene Sarosiek, MD1, Abhizith Deoker, MD1, Richard McCallum, MD, FACG1, Mohammad Bashashati, MD1; 1Texas Tech University Health Sciences Center, El Paso, TX; 2University of Kansas Medical Center, Kansas City, KSIntroduction: Gastroparesis (GP) is a syndrome presenting with refractory nausea, vomiting, early satiety, and bloating in the setting of delayed gastric emptying (GE) in the absence of mechanical obstruction. Medical management of GP is difficult, and the outcome is often poor. Metoclopramide (MCP) and domperidone are antiemetics and prokinetics with antidopaminergic activities. They produce their antiemetic effects through the chemoreceptor trigger zone, and they function as prokinetics by blocking dopamine in the stomach and proximal duodenum. Unlike domperidone, MCP is permeable to the blood-brain barrier and has a "black box" warning for tardive dyskinesia. However, domperidone is only prescribed under an Investigational New Drug protocol in the United States, mainly due to scattered reports of cardiac events related to prolonged QTc interval. In this meta-analysis, the authors sought to compare the effects of MCP and domperidone for improving GP symptoms.Methods: A search in PubMed, Embase, American College of Gastroenterology, and Digestive Disease Week abstracts database was performed to find trials on MCP and domperidone in GP. Direct and indirect comparisons of GP symptom and GE improvement with MCP and domperidone were pooled and were reported as mean (standard deviation). Random effects model was used in this meta-analysis to overcome limitations related to heterogeneity.Results: Response to MCP (3-6 weeks treatment), domperidone (4 weeks to 4 years), and domperidone vs MCP (4 weeks treatment) were examined in 5, 10, and 1 (Patterson 1999) published studies, respectively. Overall, 99 and 421 GP patients received MCP and domperidone, respectively. MCP had an overall symptom improvement rate of 48.8 (95% CI: 38.8-58.70) compared with 63.6 (95%CI: 55.1-71.7) (p< 0.05) improvement in domperidone-treated groups (Figures 1 and 2). MCP and domperidone improved GE by 19.7 (SD: 6.6) and 30.7% (SD: 13.9), respectively (p >0.05) involving different methodologies. No major adverse events, including acute coronary syndrome, serious arrhythmias, or cardiac death were reported with domperidone. Most recent studies provided QTc values which did not show any clinically significant QTc prolongation.Discussion: Domperidone demonstrates significant superiority compared to MCP. It is safe and effective in GP when administered under monitored conditions. Promotility effects of domperidone are complemented by its powerful antiemetic properties providing a clinically valuable symptom control in GP patients.Figure 1. Pooled overall gastroparesis symptom improvement rate after metoclopramide treatmentFigure 2. Pooled overall gastroparesis symptom improvement rate after domperidone treatmentDisclosures:Gian Galura indicated no relevant financial relationships. Chelsey Bravenec indicated no relevant financial relationships. Kanchana Myneedu indicated no relevant financial relationships. Reza Hejazi indicated no relevant financial relationships. Irene Sarosiek indicated no relevant financial relationships. Abhizith Deoker indicated no relevant financial relationships. Richard McCallum indicated no relevant financial relationships. Mohammad Bashashati indicated no relevant financial relationships.

P1120 (S0483). Cytokine Gene Polymorphisms in Irritable Bowel Syndrome vs Inflammatory Bowel Disease: A Network Meta-Analysis 1389256 Aaron Shanker Texas Tech University Health Sciences Center Cytokine Gene Polymorphisms in Irritable Bowel Syndrome vs Inflammatory Bowel Disease: A Network Meta-Analysis Functional Bowel Disease ePoster Session Aaron Shanker, MD1, Alejandro Robles, MD1, Abhizith Deoker, MD1, Irene Sarosiek, MD1, Nasser Ebrahimi Daryani, MD2, Ali Rezaie, MD3, Nima Rezaei, MD4, Max Schmulson, MD5, Marc Zuckerman, MD1, Mohammad Bashashati, MD1; 1Texas Tech University Health Sciences Center, El Paso, TX; 2Tehran University of Medical Sciences, Tehran, Tehran, Iran; 3Cedars-Sinai, Los Angeles, CA; 4Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran; 5Universidad Nacional Autónoma de México (UNAM), Hospital General de México, Mexico City, Distrito Federal, MexicoIntroduction: Cytokines are imbalanced in irritable bowel syndrome (IBS) and polymorphisms of cytokine-encoding genes may alter the risk of developing IBS. Whether IBS and inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), are separate entities or are on a spectrum with overlap is a question which has not been sufficiently explored. This study aimed to understand whether cytokine gene polymorphisms which are observed in IBS are also associated with IBD.Methods: We designed a network meta-analysis to compare the distribution of three cytokine gene polymorphisms that have been more frequently studied in IBS and IBD: IL-10 (-1082GA), IL6 (-174GC), and TNF-α (-308GA). PubMed and Embase were searched for studies on the distribution of these polymorphisms in IBS and IBD vs. control. NetMetaXL (CADTH, Ottawa, Canada) was used for conducting this Bayesian network meta-analysis. Vague prior < 0.5 suggested lower heterogeneity where fixed effects model was used. Odds ratio (OR) with 95% credible intervals [95% Cr.I.]. was used for the comparisons.Results: Ten studies on IBS vs. controls, one on IBS vs. IBD vs. controls, and thirty-nine comparing IBD vs. controls, were included. The high producer IL-10 (-1082GG) genotype was less frequent in IBS vs. the three other groups: Controls 0.66 [0.50 – 0.88], UC 0.66 [0.47 – 0.91], and CD 0.72 [0.52 – 0.98]; while the intermediate producer IL-10 (-1082GA) was more frequently observed in IBS vs. Controls and UC. When comparing the low producer IL-10 (-1082AA) genotype in IBS with either IBD groups or Controls, no significant difference was observed, while CD had a lower frequency of IL-10 (-1082AA) vs. Controls. The high producer TNF-α (-308AA) was similarly distributed in IBS vs. other groups and was less frequent in Controls vs. UC: 0.68 [0.46 – 0.99]. TNF-α (-308 GG and GA) was similar among the study groups. IL6 (-174GC) was less frequent in IBS vs. CD: 0.73 [0.55 – 0.98]; and in UC vs. CD: 0.69 [0.53 – 0.89]. The high producer IL6 (-174GG) was less frequent in CD vs. UC: 0.73 [0.56-0.95]; while no difference was observed in IBS vs. other groups.Discussion: IL-10 (-1082GA) has a more prominent role than TNF-α (-308GA) and IL6 (-174GC) in the pathogenesis of IBS and may distinguish IBS from IBD. There is a shift toward high producer pro-inflammatory TNF-α (-308AA) and IL6 (-174GG) in UC, distinguishing it from the other groups.Disclosures:Aaron Shanker indicated no relevant financial relationships. Alejandro Robles indicated no relevant financial relationships. Abhizith Deoker indicated no relevant financial relationships. Irene Sarosiek indicated no relevant financial relationships. Nasser Ebrahimi Daryani indicated no relevant financial relationships. Ali Rezaie indicated no relevant financial relationships. Nima Rezaei indicated no relevant financial relationships. Max Schmulson indicated no relevant financial relationships. Marc Zuckerman indicated no relevant financial relationships. Mohammad Bashashati indicated no relevant financial relationships.

P1130 (S0493). Subcutaneous Methylnaltrexone in Cancer and Non-Cancer Patients for Rapid Relief of Opioid-Induced Constipation 1389198 Eric Shah Dartmouth-Hitchcock Medical Center Subcutaneous Methylnaltrexone in Cancer and Non-Cancer Patients for Rapid Relief of Opioid-Induced Constipation Functional Bowel Disease ePoster Session Eric D. Shah, MD, MBA1, Bruce H. Chamberlain, MD, CHMD2, Michelle Rhiner, DNP, GNP-BC, ACHPN3, Neal E. Slatkin, MD4, Nancy Stambler, DrPH5, Robert J. Israel, MD6; 1Dartmouth-Hitchcock Medical Center, Lebanon, NH; 2Genesis Healthcare, Davenport, IA; 3Loma Linda University Health, Loma Linda, CA; 4University of California Riverside, Salix Pharmaceuticals, Bridgewater, NJ; 5Progenics Pharmaceuticals, Inc., New York, NY; 6Bausch Health US, LLC, Bridgewater, NJIntroduction: Rapid relief of opioid-induced constipation (OIC) is often necessary in acute care settings for patients with cancer and chronic noncancer pain. Methylnaltrexone (MNTX) is the only FDA approved peripherally acting µ-receptor antagonist with a subcutaneous (SC) formulation for OIC. We report the ability of MNTX SC to achieve early rescue-free laxation (RFL) in advanced-illness OIC patients with and without cancer.Methods: Two multicenter, double-blind, randomized, placebo-controlled studies (study 302 [NCT00402038] and study 4000 [NCT00672477]) were conducted in adults with advanced illness and OIC ( >98% of whom were laxative refractory). In study 302, patients from 27 sites (26 US; 1 Canada) were randomized 1:1 to receive MNTX SC 0.15 mg/kg or placebo every other day for 2 weeks. In study 4000, patients from 48 US and international sites were randomized 1:1 to receive MNTX SC based on body weight (8 or 12 mg) or placebo for ≤7 doses for 14 days. Endpoints included the proportion of patients achieving RFL within 4 hours after the first dose (co-primary endpoint for study 302; endpoint for study 4000); the proportion of patients with an RFL within 4 hours for ≥2 of the first 4 doses (co-primary endpoint for study 302; primary endpoint for study 4000); changes from baseline in pain scores; and safety. Patients were stratified by active cancer versus noncancer. RFL response was analyzed by chi-square tests; the nominal significance level was 0.05, with no multiplicity adjustment. Results: Study 302 included 78 cancer patients (MNTX n=37; placebo n=41) and 56 noncancer patients (MNTX n=26; placebo n=30) . Study 4000 included 152 cancer patients (MNTX n=79; placebo n=73) and 78 noncancer patients (MNTX n=37; placebo n=41) . In both studies, significantly greater proportions of patients treated with MNTX versus placebo achieved an RFL within 4 hours after the first dose among cancer and noncancer patients (Figure 1). Repeat dosing with MNTX SC also maintained bowel symptom response within 4 hours in both cohorts (Figure 2). No significant changes in pain scores were observed between treatment groups in either study . The most common adverse events were abdominal pain, flatulence, and nausea.Discussion: In two individual studies, MNTX use effectively reduced OIC within 4 hours of the first dose and maintained bowel symptom response with repeat dosing in cancer and noncancer patients without affecting central opioid receptor mediated analgesia.Figure 1. Patients achieving a rescue-free laxation within 4 hours of the first doseFigure 2. Repeat dosing with MNTX SC (RFL within 4 hours for ≥2 of the first 4 injections) maintained bowel symptom response in cancer and noncancer patients (ITT population)Disclosures:Eric Shah indicated no relevant financial relationships. Bruce Chamberlain indicated no relevant financial relationships. Michelle Rhiner: Salix Pharmaceuticals – Other Financial or Material Support, Travel expenses related to poster presentations at the 2018 World Congress on Regional Anesthesia & Pain Medicine and the 2018 Palliative and Supportive Care in Oncology meeting.. Wyeth Pharmaceuticals – Grant/Research Support.Neal Slatkin: Salix Pharmaceuticals, a subsidiary of Bausch Health US. – Employee.Nancy Stambler: Progenics Pharmaceuticals, Inc. – Employee.Robert Israel: Bausch Health US, LLC. – Employee.

P1140 (S0503). Efficacy of Complementary and Alternative Medicine (CAM) in Adults With Irritable Bowel Syndrome (IBS): A Systematic Review and Meta-Analysis of Randomized Controlled Trials 1387957 Wade Billings Indiana University School of Medicine Efficacy of Complementary and Alternative Medicine (CAM) in Adults With Irritable Bowel Syndrome (IBS): A Systematic Review and Meta-Analysis of Randomized Controlled Trials Functional Bowel Disease ePoster Session Wade Billings, MD, Karan Mathur, MD, Hannah J. Craven, MLIS, Huiping Xu, PhD, Andrea Shin, MD, MSc; Indiana University School of Medicine, Indianapolis, INIntroduction: Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders in the world. Many patients with IBS seek complementary and alternative medicine (CAM), even when they are satisfied with conventional therapy. It is thus important for clinicians to understand the available evidence for CAM. The aim of this study was to perform a systematic review and meta-analysis examining the efficacy of CAM including herbal and dietary supplements, mind-body intervention, body-based methods, and energy-based therapies compared to placebo or sham therapy in adults with IBS. Methods: A literature search of Ovid MEDLINE and Embase for randomized, placebo-controlled trials of CAM in adults with IBS was completed. Data were extracted to obtain pooled estimates of mean improvement in abdominal pain severity (standardized mean difference [SMD]) and relative risk (RR) of overall response using random effects models. Heterogeneity was assessed using the Higgins and Thompson I2 statistic. Risk of bias was assessed using the Cochrane Collaboration Tool. Publication bias was tested using a funnel plot and Egger’s test.Results: The literature search identified 2053 articles; sixty were included in the final analysis (Figure 1): 50 for abdominal pain and 41 for overall response. Fourteen studies were considered to be at low risk of bias. Pooled analysis of effect on abdominal pain favored CAM (SMD=-0.25, 95% CI -0.41 to -0.08), but with moderate heterogeneity (I2=72%) between studies. Subgroup analysis (Figure 2) showed benefit with herbal (SMD=-0.36, 95% CI -0.62 to -0.10, I2=76%,) and mind-body based therapy (SMD=-0.22, 95% CI -0.42 to -0.01, I2=65%), although heterogeneity persisted. There was a significant effect on overall response favoring CAM (RR=1.54, 95% CI 1.34 to 1.77), but with moderate heterogeneity (I2=64%). Subgroup analysis (Figure 3) showed significant benefit with each class of CAM over placebo with the exception of body-based and energy healing therapies. No statistically significant evidence of publication bias was found. No study reported serious adverse events.Discussion: Findings suggest that CAM may be beneficial compared to placebo for abdominal pain and overall response. However, moderate heterogeneity between studies was observed and the majority of studies were considered to be at moderate to high risk of bias. More high quality placebo-controlled RCTs are warranted to further assess CAM therapy in IBS.Figure 1. Study SelectionFigure 2. Forest plot of studies of CAM vs. placebo for effect on abdominal pain by therapy classFigure 3. Forest plot of studies of CAM vs. placebo for effect on overall response by therapy classDisclosures:Wade Billings indicated no relevant financial relationships. Karan Mathur indicated no relevant financial relationships. Hannah Craven indicated no relevant financial relationships. Huiping Xu indicated no relevant financial relationships. Andrea Shin indicated no relevant financial relationships.

P1150 (S0513). 3 Years and 1 Million Patients: Safety Data on Caraway Oil and L-menthol With Site Specific Targeting (COLM-SST) for Functional Dyspepsia 1389166 Brian Lacy Mayo Clinic 3 Years and 1 Million Patients: Safety Data on Caraway Oil and L-menthol With Site Specific Targeting (COLM-SST) for Functional Dyspepsia Functional Bowel Disease ePoster Session Brian E. Lacy, MD, PhD, FACG1, Michael Epstein, MD2, Patrick Corsino, PhD3; 1Mayo Clinic, Jacksonville, FL; 2IM HealthScience, Annapolis, MD; 3IM HealthScience, Boca Raton, FLIntroduction: Functional Dyspepsia (FD) is a common functional GI disorder. The estimated prevalence is 15-30% worldwide. There are currently no FDA-approved medications for its treatment. Proton pump inhibitors (PPIs) are often prescribed off-label although are not very effective. In addition, long-term use of these drugs has been associated with serious health concerns. Prokinetics are also often used off-label. However, many are associated with side effects (e.g. metoclopramide). A safe, effective, and readily available treatment option for FD is greatly needed.We describe the results of an important 36-month post-marketing analysis of COLM-SST, an over-the-counter medical food demonstrated to be safe and efficacious in an RCT. Previous RCTs showed that the combination of caraway oil and peppermint oil improves FD symptoms. Caraway oil plus L-menthol (the major component of peppermint oil) with site-specific targeting (COLM-SST) is a novel delivery system of triple-coated, solid-state microspheres designed to target the duodenum, the main center of disturbance in FD. This study was conducted to report on the overall safety profile of COLM-SST and to determine if unexpected patterns of side effects emerged.Methods: A call-in number for reporting adverse events (AEs) was provided on all boxes of COLM-SST. An independent call center with pharmacovigilance-trained health care personnel, in accordance with the FDA and global regulatory guidelines on properly reporting AEs, was retained to receive and record customer AEs. Data was collected and processed from July 2016 to July 2019.Results: An estimated 1,098,162 patients used COLM-SST during the surveillance. No serious AEs were reported. Additionally, the rate of non-serious AEs was low, with only 205 events received (from 179 patients), a rate of 0.019%. The top-reported, non-serious AEs were abdominal pain/discomfort/distension (35; 0.0032%), which are consistent with the pattern of commonly reported presenting symptoms of FD, and dyspepsia (22; 0.0020%), the underlying condition itself (Table 1). No pattern of AEs associated with drug interactions was identified.Discussion: 36 months of monitoring in-market, real-world use of COLM-SST for the treatment of FD demonstrates an extremely low rate of self-reported AEs. Interestingly, the number and rate of AEs over time has decreased (Fig 1). These data, combined with earlier RCT data, indicates that COLM-SST is a safe and effective therapy for FD, and is a viable alternative to PPIs and prokinetics.Table 1 - 10 most common AEsFigure 1a - AE report rates by yearFigure 1b – Adverse event numbers by yearDisclosures:Brian Lacy: IM Health – Consultant.Michael Epstein: IMHEALTHSCIENCE – Consultant.Patrick Corsino: IM HealthScience – Employee.

P1170 (S0524). Safety Profile of Endoscopist-Directed Balanced Propofol Sedation for Procedural Sedation: An Experience at a Hospital-Based Endoscopy Unit 1388716 Hala Fatima Indiana University School of Medicine Safety Profile of Endoscopist-Directed Balanced Propofol Sedation for Procedural Sedation: An Experience at a Hospital-Based Endoscopy Unit General Endoscopy ePoster Session Thomas F. Imperiale, MD1, Hala Fatima, MD2; 1Indiana University Medical Center, Indianapolis, IN; 2Indiana University School of Medicine, Indianapolis, INIntroduction: Nurse administered propofol sedation was widely used for endoscopic procedures until 2009 when its use was restricted to anesthesiologists per CMS guidelines, a practice that has led to increases in healthcare costs. Aim was to evaluate the safety of endoscopist-directed balanced propofol sedation (EDBPS) for endoscopy.Methods: We identified patients who underwent endoscopic procedures with EDBPS from Jan to Jun 2017. Medical records were abstracted for data on procedure indication, medication doses, time to induction of sedation, duration of procedure and recovery time. Adverse events (AEs) included: Hypoxia - oxygen saturation (SPO₂) 50 mm Hg, c) Drop in mean arterial pressure (MAP) >30%; Bradycardia (heart rate Results: A total of 1897 patients received EDBPS during the study period. Mean age was 55 (SD 11.4) years and 43.6% were men. Patients received median doses of 50 mcg fentanyl and 2 mg of midazolam and a mean propofol dose of 160 ± 99 mg (range 20-960). Mean time for sedation induction was 3.4 (SD 1.9) and mean recovery was 14 (SD 10.2) min. There were no major complications (0%; 95% CI, 0-0.19%). Three hundred thirty-four patients (17.6%) experienced an AE, all of which were managed with simple measures (chin-lift, jaw thrust and increasing flow of O₂ and IV fluids): 65 (3.4%) had transient hypoxia, 277 (14.6%) had hypotension. In bivariate analysis, a 5-yr increase in patient age was associated with in increased risk of hypotension. A 50 mg increase in propofol dose was associated with a statistically significant risk of transient hypoxia. A 10-min increase in procedure duration was associated with statistically significant risk of both transient hypoxia and hypotension (Table 1). Age, weight, BMI, propofol dose and procedure length were associated with AEs (Table 2). Gender had no association with AEs. In multivariate analysis, only procedure length was independently associated with AEs. Discussion: EDBPS is safe for endoscopic procedural sedation, as AEs occurred infrequently. Given the much higher cost of anesthesia-administered propofol for routine endoscopic procedures, endoscopists should re-instate EDBPS by revising institutional sedation policies.Disclosures:Thomas Imperiale indicated no relevant financial relationships. Hala Fatima indicated no relevant financial relationships.

P1180 (S0534). The Recurrence Rates of Resected Colon Polyps With Underestimated and Overestimated Sizes 1387737 Lindsey Bierle The Recurrence Rates of Resected Colon Polyps With Underestimated and Overestimated Sizes General Endoscopy ePoster Session Lindsey A. Bierle, DO1, Mohamad Mouchli, MD1, Shravani R. Reddy, MD1, Christopher Walsh, MD2, Adil S. Mir, MD1, Paul Yeaton, MD2; 1Carilion Clinic, Roanoke, VA; 2Virginia Tech Carilion, Roanoke, VAIntroduction: Accurate measurement of colon polyp size can be challenging since there is not an easily identifiable way to provide precise measurements, as most are based on uncertain visual estimation. The actual size can sometimes not be accurately estimated due to many reasons including inter-endoscopist variability.We aimed to compare the frequency and recurrence rates among underestimated and overestimated polyp sizes by comparing endoscopist and pathologist measurements.Methods: We randomly selected patients with colon polyps (measuring Results: One-hundred and twenty-eight (Mean age, 63.6±11.3 years; 47.3% males) with colon polyps were identified. Comparing the polyp size in the endoscopy report with the size in the pathology report, 37.5% had the same size, 21.9% were smaller, and 40.6% were bigger in the endoscopy reports. Advanced endoscopists underestimated the size in 33.3% and overestimated the size in 29.6% (compared to 13.5% and 48.7% among non-advanced endoscopists). The size was underestimated in polyps removed in piecemeal fashion by 30.5% and overestimated in 25.6% (compared to 6.3% and 67.4% via en bloc). The discrepancy would change the surveillance interval in 35.7% in underestimated polyps and 26.9% in overestimated polyps. The recurrence rates were not different between polyps with underestimated and overestimated sizes (0.43).Discussion: There is discrepancy between endoscopists and pathologists regarding the actual size of colon polyps in roughly 60% of the reports reviewed. This is a very important issue to resolve given its effect on surveillance intervals in polyps measuring around one centimeter.Polyp Size in Relation to Time to RecurrenceDisclosures:Lindsey Bierle indicated no relevant financial relationships. Mohamad Mouchli indicated no relevant financial relationships. Shravani Reddy indicated no relevant financial relationships. Christopher Walsh indicated no relevant financial relationships. Adil Mir indicated no relevant financial relationships. Paul Yeaton indicated no relevant financial relationships.

P1190 (S0544). Endoscopic Management of Post-Pancreaticoduodenectomy Delayed Gastric Emptying 1389785 Cristina Calogero Thomas Jefferson University Hospital Endoscopic Management of Post-Pancreaticoduodenectomy Delayed Gastric Emptying General Endoscopy ePoster Session Cristina Calogero, MD1, Divya Chalikonda, MD1, Clifford Yudkoff, BS2, Ava Torjani, BS2, Taylor Kavanagh, MS, BS2, Hamza Rshaidat, BS2, Elwin Tham, MD1, Cyrus Sholevar, BS2, Alexandra Leto, BS2, William Preston, MD1, Mandeep Shergill, BS3, Geoffrey Krampitz, MD, PhD1, Harish Lavu, MD1, Charles J. Yeo, MD1, C. Andrew Kistler, MD, PharmD1; 1Thomas Jefferson University Hospital, Philadelphia, PA; 2Thomas Jefferson University School of Medicine, Philadelphia, PA; 3Thomas Jefferson University, Philadelphia, PAIntroduction: Delayed gastric emptying (DGE) is a common cause of post-operative morbidity after pancreaticoduodenectomy (PD). The etiology of DGE is multifactorial and can include disturbances in muscular, hormonal, and neurologic function affecting overall motility. Endoscopic management has been used in patients with refractory DGE at our institution. We aimed to identify those post-PD patients with DGE who underwent endoscopy, characterize their demographics and risk factors, as well as summarize their outcomes.Methods: This was a single-center retrospective cohort study evaluating patients who underwent PD between 2017 and 2020. Primary endpoints included modified International Study Group on Pancreas Surgery (ISGPS) DGE severity, endoscopic intervention for DGE, and resolution of DGE symptoms following endoscopy as assessed by time to nasogastric tube removal and toleration of full liquid diet. Secondary endpoints included gender, age, presence of diabetes mellitus (DM) (I or II), type of PD (pylorus-preserving versus classic), type of anastomosis, and post-operative day (POD) of initial DGE symptoms.Results: Of the 281 patients reviewed, DGE developed in 55 (19.6%) patients. Of those with DGE, 34 (61.8%), 13 (23.6%), and 8 (14.5%) were categorized as Grade A, B, and C, respectively, with 9 (16.3%) patients requiring endoscopic evaluation (Table 1). Of the 9 patients who underwent endoscopy, the median age was 67.3 (±12.8) years, 5 (55.6%) were men, none had DM, 4 (44.4%) were classified as Grade B, and 5 (55.6%) were classified as Grade C. The median time to onset of DGE symptoms was 4 days, and the median time to endoscopic intervention was 15 days. Only 1/3 of patients required balloon dilation of stricture or angulation during endoscopy, and 7 (77.8%) patients had immediate improvement in DGE symptoms post-endoscopy.Discussion: Endoscopic intervention may play a role in the treatment of patients that are post-PD with Grade B or higher DGE who are refractory to medical therapies. Our data suggests that regardless of the type of PD or whether balloon dilation is performed endoscopically, patients with grade B or higher DGE may benefit from endoscopy and overall have resolution in their symptoms within one day of the procedure.Table 1Disclosures:Cristina Calogero indicated no relevant financial relationships. Divya Chalikonda indicated no relevant financial relationships. Clifford Yudkoff indicated no relevant financial relationships. Ava Torjani indicated no relevant financial relationships. Taylor Kavanagh indicated no relevant financial relationships. Hamza Rshaidat indicated no relevant financial relationships. Elwin Tham indicated no relevant financial relationships. Cyrus Sholevar indicated no relevant financial relationships. Alexandra Leto indicated no relevant financial relationships. William Preston indicated no relevant financial relationships. Mandeep Shergill indicated no relevant financial relationships. Geoffrey Krampitz indicated no relevant financial relationships. Harish Lavu indicated no relevant financial relationships. Charles Yeo indicated no relevant financial relationships. C. Andrew Kistler indicated no relevant financial relationships.

P1200 (S0554). The First Year Fellow Effect: Adenoma Detection Rate (ADR) Associated With Gastroenterology Trainees 1389033 Hajra Khan Wayne State University, Detroit Medical Center The First Year Fellow Effect: Adenoma Detection Rate (ADR) Associated With Gastroenterology Trainees General Endoscopy ePoster Session Hajra Khan, MD1, Salina Faidhalla, MD1, Heba Habbal, MD2, Hamid-Reza Moein, MD1, Eskara Pervez, MD1, Anshu Wadehra, MD1, Mahvish Khalid, MD1, Diana Kakos, BS3, Paul Naylor, PhD4, Bashar Mohamad, MD5; 1Wayne State University, Detroit Medical Center, Detroit, MI; 2Oakwood Hospital and Medical Center, Dearborn, MI; 3Wayne State University, School of Medicine, Detroit, MI; 4WSU, Detroit, MI; 5WSUPG, Detroit, MIIntroduction: There is conflicting data on the impact of trainees on adenoma detection during screening and surveillance colonoscopies. The aim of our study was to determine whether the participation of a gastroenterology fellow during colonoscopy affects adenoma detection based on the first 6 months of the fellow year of training.Methods: In this retrospective cohort study, we extracted data of 575 screening colonoscopies by academic gastroenterologists in the last 6 months of 2017. There were 5 attending physicians and 7 fellows. Variables included patient demographics (age, gender, race), colonoscopy indication (surveillance vs. screening), bowel preparation quality (adequate vs. inadequate), cecum intubation, adenoma detection, presence and/or year of fellow in the last 6 months of 2017. Adenoma detection rate was defined as the presence of at least one adenoma /number of colonoscopies.Results: At our institution, academic physicians have a better ADR for screening (46%) as compared to non-Academic GI physicians (46%) and surgeons. Fellows were involved in 297 screening colonoscopies out of the 574 procedures performed by academic GI (57%) . The mean patient age was 58.4 years, and most patients were African American (88 %) and female (54%). There were no significant differences with respect to age, gender, race, indication for colonoscopy, or quality of bowel prep. There was a slight difference with cecum intubation between fellows and attendings (96% vs. 99%, p = 0.03). The overall adenoma detection was similar with fellow participation compared to non-fellow (45% vs. 40%, p = 0.19). Results by year of fellowship and screening colonoscopies are shown in figure 1. The only setting where fellow participation influenced the detection of adenoma was in the first 6 months of fellowship for screening colonoscopies which were lower with fellows compared to the other groups (p=0.048).Discussion: Fellow involvement had minimal impact on adenoma detection, although first year fellows appear to have a slightly lower detection rate than in later years. Our data accentuates the first-year fellow effect by using only the first 6 months of each fellow’s respective year. Patient demographics, colonoscopy indication and bowel prep did not contribute a significant role in these findings. The reasons for conflicting literature remain unknown.Figure 1: The % of patients with an adenoma (ADR) as a function of the year of GI fellowship. Also presented on the graph is the ADR for attending faculty when no fellow was present.Disclosures:Hajra Khan indicated no relevant financial relationships. Salina Faidhalla indicated no relevant financial relationships. Heba Habbal indicated no relevant financial relationships. Hamid-Reza Moein indicated no relevant financial relationships. Eskara Pervez indicated no relevant financial relationships. Anshu Wadehra indicated no relevant financial relationships. Mahvish Khalid indicated no relevant financial relationships. Diana Kakos indicated no relevant financial relationships. Paul Naylor indicated no relevant financial relationships. Bashar Mohamad indicated no relevant financial relationships.

P1210 (S0564). Understanding the Impact of the COVID-19 Pandemic on Inpatient Gastrointestinal Procedures: A Single Center Study 1390092 Ysabel Ilagan-Ying Yale New Haven Hospital Understanding the Impact of the COVID-19 Pandemic on Inpatient Gastrointestinal Procedures: A Single Center Study General Endoscopy ePoster Session Award: Presidential Poster AwardYsabel Ilagan-Ying, MD1, Mariana N. Almeida, BA2, Arianna Kahler-Quesada, BS2, Lee Ying, MD, PhD1, Albert Do, MD, MPH2, Michelle L. Hughes, MD2, Kenneth H. Hung, MD, MS2; 1Yale New Haven Hospital, New Haven, CT; 2Yale School of Medicine, New Haven, CTIntroduction: The COVID-19 pandemic has impacted the way care is provided and led to healthcare systems restructuring service lines for patients with COVID-19. The impact of this on inpatient endoscopy is not yet known. We studied patterns of inpatient gastrointestinal (GI) procedures to evaluate the effect of the COVID-19 pandemic on inpatient endoscopy utilization patterns and patient characteristics.Methods: We retrospectively reviewed all inpatient endoscopic procedures performed on patients 18 years or older at a large academic medical center and its affiliate hospital from 3/1/2019-4/30/2019 (control) and 3/1/2020-4/30/2020 (COVID-19). Patient demographics were recorded, and zip codes referenced with census data for population statistics. Cases were categorized by indication and urgency. Demographic and procedural characteristics were then compared between COVID-19 and control groups.Results: There were 784 patients who underwent 1,032 procedures. Compared to 2019, inpatient endoscopy volume decreased from 611 to 421, with an increase in proportion of urgent and traveling/outside of endoscopy suite procedures (Fig. 1). There was no difference in age, sex, or median income. A decreased proportion of Black patients underwent procedures, 20% in 2019 vs.13.7% in 2020 (p=0.02). There was no difference in procedure types, but an increased proportion of procedures conducted outside the endoscopy suite in 2020 (Table 1). Indications for urgent procedures differed in distribution in 2020, with a decreased proportion of procedures for GI bleeding and an increased proportion of procedures for biliary obstruction (p=0.003). Patients undergoing emergent procedures in 2020 were significantly younger than patients undergoing urgent procedures when compared to 2019 (p=0.001) (Fig. 2).Discussion: During the peak of COVID-19, decreased volumes in inpatient GI procedures were observed with changing proportions of urgent and traveling cases. The decline in the proportion of Black patients undergoing endoscopic interventions in 2020 suggest a possible disparity in access to endoscopy or hesitancy towards health care utilization. Additionally, the average age of patients receiving emergent procedures were significantly younger during COVID-19, suggesting that older patients who need emergent procedures may not be receiving them. Further study is needed to understand the effects of the COVID-19 era on patient care, access, and health services-related outcomes.Table 1. Characteristics of Patients and Inpatient Gastrointestinal Procedures in 2019 (Control) Compared to 2020 (COVID-19)Figure 1. Distribution of Inpatient Gastrointestinal Procedures by Urgency Status (Emergent, Urgent, and Non-Urgent) in 2019 (Control) Compared to 2020 (COVID-19)Figure 2. Average Age of Patients Undergoing Urgent and Emergent Inpatient Gastrointestinal Procedures in 2019 (Control) Compared to 2020 (COVID-19)Disclosures:Ysabel Ilagan-Ying indicated no relevant financial relationships. Mariana Almeida indicated no relevant financial relationships. Arianna Kahler-Quesada indicated no relevant financial relationships. Lee Ying indicated no relevant financial relationships. Albert Do indicated no relevant financial relationships. Michelle Hughes indicated no relevant financial relationships. Kenneth Hung indicated no relevant financial relationships.

P1220 (S0574). Analysis of All-Inclusive Upper Gastrointestinal Foreign Body Findings and Management 1388294 Steven Delaney Wake Forest Baptist Health Analysis of All-Inclusive Upper Gastrointestinal Foreign Body Findings and Management General Endoscopy ePoster Session Steven Delaney, MD1, Zach Harris, MD1, Steven Clayton, MD2; 1Wake Forest Baptist Health, Winston-Salem, NC; 2Wake Forest University, School of Medicine, Winston-Salem, NCIntroduction: Esophageal and gastric foreign bodies classically involve food in adults and coins, toys, batteries, magnets, marbles, and other small objects in children. However, limited studies have been published regarding the removal of iatrogenic foreign bodies. We aimed to catalog and analyze a comprehensive spectrum of foreign bodies removed by EGD. We accomplished this by comparing the findings and management of the foreign bodies by dividing them into three major groups: food based, iatrogenic, and “others” (intentional and unintentional non-food ingestions) to detect if there were significant differences.Methods: We conducted a retrospective review of all foreign bodies removed via EGD over a 3-year period. Our study was IRB approved and conducted at a tertiary medical center. We collected demographic variables, medical history, objects removed, removal method, and outcomes. All of these cases were analyzed with descriptive statistics. Categorical data was analyzed using the Chi-Square test while quantitative data was analyzed by ANOVA. A p-value < 0.05 was considered significant.Results: Over a 3-year period, there were 401 encounters for foreign body removed by EGD. Iatrogenic made up the majority of the encounters with 232 patients, followed by food at 136, and “others” (intentional and unintentional non-food ingestions) at 33. As presented in table 1, when comparing the three groups, we found significant differences in age (p< 0.05), gender (p< 0.001), insurance status (p=0.002), PCP status (p=0.002), if follow up was scheduled (p< 0.001), and if the patient presented to follow-up (p=0.032). In addition, there were significant differences in the removal method between groups when comparing single vs. multiple modalities and graspers vs. non-graspers (p< 0.001). When combining all 3 groups together, utilizing a single device compared to multiple devices was more common and successful (79.8% vs 20.2%, p< 0.001). The top object removed was food in 132 cases followed by staples in 98 patients.Discussion: We aimed to study differences between the complete spectrum of upper GI foreign bodies. Dividing the data between 3 major categories, we found multiple differences between demographics and successful removal methods. We were also able to list the objects removed. Inclusion of all objects including iatrogenic should shed light on what is being removed along with removal method for a typical GI department at tertiary medical center.*Intentional and unintentional non-food ingestions. Table 1: Demographics.*Intentional and unintentional non-food ingestions. Figure 1: Extraction Device or Method as a Total and Divided between Groups.Figure 2: Objects Extracted.Disclosures:Steven Delaney indicated no relevant financial relationships. Zach Harris indicated no relevant financial relationships. Steven Clayton indicated no relevant financial relationships.

P1230 (S0584). The Safety of Endoscopy Among Patients on Antiangiogenic Agents: A 5-year Retrospective Single Center Experience 1389992 Mohammad Azam Medical College of Georgia The Safety of Endoscopy Among Patients on Antiangiogenic Agents: A 5-year Retrospective Single Center Experience General Endoscopy ePoster Session Mohammad U. Azam, MD1, Pearl Princess Uy, MD1, Amit Hudgi, MBBS1, Mohammad Maysara Asfari, MD1, Eula P. Tetangco, MD, MPH2, John Erikson L. Yap, MD2; 1Medical College of Georgia, Augusta, GA; 2Medical College of Georgia at Augusta University, Augusta, GAIntroduction: Antiangiogenic agents (AAs) have been increasingly used for the treatment of malignant tumors but are reported to be associated with a higher risk of gastrointestinal (GI) bleeding and perforation. Elective surgery is usually delayed 28 days after AAs treatment. Data is limited regarding the safety of endoscopy while on AAs. The primary aim of this study is to determine the procedure-related adverse effects (AE) and death among patients who had endoscopic procedures while on AAs.Methods: Patients who underwent an endoscopic procedure from January 1, 2015 – March 31, 2020 and received AAs including vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor (VEGFR) inhibitors, epidermal growth factor receptor (EGFR) inhibitors, multi-targeted tyrosine kinase inhibitors, and mammalian target of rapamycin (mTOR) inhibitor within 28 days were included. Data collected included demographic information, type of malignancy, type and timing of AA used, procedure-related AE and death within 30 days of endoscopy. Endoscopic procedures were also categorized into high and low-risk based on risk of perforation and GI bleeding. Data were analyzed with descriptive statistics. This study was approved by the Institutional Review Board for Augusta University.Results: 66 patients (male/female= 26/40) with a mean age of 65 years underwent a total of 85 endoscopic procedures within 28 days of treatment with AAs. 53% (35/66) had metastatic disease and most common primary sites include colorectal (22.7%), ovarian (13.6%), and liver (12.1%). Of the 85 endoscopic procedures performed, 22 (25.9%) were considered high-risk which include variceal banding, percutaneous gastrostomy tube placement, pneumatic balloon dilation, and stent placement, whereas 63 (74.1%) were low-risk. The average duration from administration of AAs to endoscopy was 9.8 days. There were no procedure-related adverse effects, but a patient on Lenvatinib for metastatic hepatocellular carcinoma had persistent bleeding despite esophageal variceal banding and died 4 days later from hemorrhagic shock.Discussion: In this single center retrospective study, the rate of procedure-related AE and death within 30 days of endoscopy on AAs appear to be low. This is consistent with a published data by Kachaamy et al. As gastroenterologist, understanding endoscopic-related and medication adverse effects are crucial for optimal patient care. Future prospective studies are needed to confirm these findings.Table 1: Baseline Characteristics of the Study PopulationTable 2: List of Antiangiogenic AgentsDisclosures:Mohammad Azam indicated no relevant financial relationships. Pearl Princess Uy indicated no relevant financial relationships. Amit Hudgi indicated no relevant financial relationships. Mohammad Maysara Asfari indicated no relevant financial relationships. Eula Tetangco indicated no relevant financial relationships. John Erikson Yap indicated no relevant financial relationships.

P1300 (S0613). The Role of Fecal Occult Blood Testing (FOBT) in Acute Care Settings in a Large Tertiary Care Hospital 1390119 Sarah Sadek University at Buffalo The Role of Fecal Occult Blood Testing (FOBT) in Acute Care Settings in a Large Tertiary Care Hospital GI Bleeding ePoster Session Sarah Sadek, MD1, Muhammad Tahir, MD1, Gina Sparacino, MD2, Yousef Fazel, MD1, Randy Cheung, MD1, Gregory D. Gudleski, PhD1, Sultan Mahmood, MD1; 1University at Buffalo, Buffalo, NY; 2University at Buffalo, Amherst, NYIntroduction: Gastrointestinal bleeding (GIB) is associated with substantial morbidity in the inpatient setting. Many studies have shown that GIB can be a substantial clinical and economic burden to the patient and the healthcare system. FOBT has been commonly used by physicians for symptoms evaluation and diagnostic testing in the hospital setting without clear guidelines. The primary objective of this study is to determine the clinical utility of fecal occult blood testing (FOBT) for the identification of GIB in acute care settings.Methods: This is an interim analysis of a single center retrospective study of 108 patients who presented with occult GI bleeding from January 2019 to December 2019 in a large tertiary care hospital. Occult GIB was defined as bleeding that is not visible to the physician or the patient. Those patients underwent FOBT testing as part of their evaluation and also had an endoscopic intervention throughout their hospital course. Active bleeding, 30- day mortality, 30-day re-bleeding, and need for intervention during endoscopy were investigated and compared amongst those who were FOBT positive and those who were negative. Chi-square analyses were used to determine significant differences between the groups.Results: The baseline characteristics of the study population presenting with occult GI bleeding are shown in Table 1. Firstly, there were no significant association between FOBT testing results and active GI bleeding upon endoscopic evaluation. Within 11 patients who were found to have active GI bleeding, FOBT testing was positive in 72.7% of them with an OR 0.751 (95%CI; 0.501-1.126). Moreover, there was no association found that was statically significant between FOBT testing results and the need for endoscopic intervention. Within 15 patients who had intervention performed, FOBT testing was positive in 46.7% of them with an OR 1.244 (95% CI; 0.705-2.196). Similarly, there were no association between FOBT results and types of endoscopic interventions performed which can be reviewed in Table 2 and Graph 1. Discussion: Our study showed that there was no association between positive FOBT test and need for endoscopic intervention, 30-day re-bleeding or 30-day mortality. Our study adds to the growing evidence that FOBT test is unlikely to change management of patient and shouldn’t be used in the hospitalized patients.Table 1Table 2Graph 1Disclosures:Sarah Sadek indicated no relevant financial relationships. Muhammad Tahir indicated no relevant financial relationships. Gina Sparacino indicated no relevant financial relationships. Yousef Fazel indicated no relevant financial relationships. Randy Cheung indicated no relevant financial relationships. Gregory Gudleski indicated no relevant financial relationships. Sultan Mahmood indicated no relevant financial relationships.

P1310 (S0623). Time Trends and Outcomes of Inter-Hospital Transfer in Patients With Upper Gastrointestinal Bleeding: A Nationwide Analysis 1390056 Mary Sedarous McMaster University Time Trends and Outcomes of Inter-Hospital Transfer in Patients With Upper Gastrointestinal Bleeding: A Nationwide Analysis GI Bleeding ePoster Session Mary Sedarous, MBBS1, Quazim A. Alayo, MD, MSc, MMSc2, Obioma Nwaiwu, MD, PhD3, Philip Dinh, MD4, Kavitha Subramanian, MD4, Philip N. Okafor, MD, MPH5; 1McMaster University, Ontario, ON, Canada; 2St. Luke's Hospital, Chesterfield, MO; 3University of Arkansas for Medical Sciences, Little Rock, AR; 4Stanford Hospital, Stanford, CA; 5Stanford University School of Medicine, Redwood City, CAIntroduction: Inter-hospital transfers occur commonly in clinical practice. However, outcomes in acute upper gastrointestinal bleed (UGIB) transfer patients have not been well described. Using a national database, we aimed to describe time-trends and outcomes in patients transferred to new hospitals with UGIB within the United States. Methods: Adults with UGIB (defined using ICD-9 codes for acute variceal hemorrhage -AVH and acute nonvariceal hemorrhage-ANVH) were identified in the 2007-2014 National Inpatient Sample. Trends in inter-hospital UGIB transfers, along with patient and hospital-level descriptors were examined. Outcomes including all-cause in-hospital mortality, upper endoscopy (EGD) utilization, length of stay (LOS), and total hospital costs (THC) were also assessed after controlling for confounding variables. Results: We identified 1,523,519 ANVH discharges of which 66,974 (4.3%) were transferred to a recipient hospital; 218,748 AVH discharges were identified of which 7,857 (9%) were transfers. Between 2007- 2014, there was a rise in AVH and ANVH transfers in the US (p=0.02, Fig 1). The mean age at transfer was lower in AVH compared to ANVH (55 vs. 64 years) with the majority of transfer patients being White, on Medicare, and living below the median level of income [Table 1]. Twenty-seven percent of UGIB transfers occurred during the weekends, predominantly to teaching hospitals 71.9% (ANVH) and 79.9% (AVH). While 52% of ANVH transfers went to hospitals with a low/medium- volume of UGIB discharges, majority of AVH transfers went to high-volume hospitals (54.2%). In addition to poor UGIB outcomes, the adjusted odds of all-cause in-hospital mortality was significantly higher in transferred ANVH patients (adjusted Odds Ratio [aOR] 1.81, 95% Confidence Interval [C.I.] (1.52-2.14) and in transferred AVH patients (aOR=1.44, 95% CI 1.52-2.1). EGD utilization was also significantly lower in transferred patients at their new hospitals where they had longer LOS and incurred higher hospital costs [Table 2].Discussion: Inter-hospital transfers for UGIB are on the rise in the US and these patients appear to be a vulnerable group with significantly lower odds of getting an EGD when they arrive recipient hospitals but with significantly higher adjusted odds of death, LOS, THC at the new hospitals. More research is needed to identify high-performing recipient hospitals to improve UGIB outcomes in this high-risk group.Figure 1: Trends in inter-hospital transfer of acute non-variceal hemorrhage (ANVH) and acute variceal hemorrhage (AVH).Table 1: Baseline demographics and comorbidity of inter-hospital transfer patients with acute non-variceal hemorrhage (ANVH) and acute variceal hemorrhage (AVH).Table 2: Crude and adjusted odds ratio and mean ratios of outcomes of inter-hospital transfer patients with acute non-variceal hemorrhage (ANVH) and acute variceal hemorrhage (AVH).Disclosures:Mary Sedarous indicated no relevant financial relationships. Quazim Alayo indicated no relevant financial relationships. Obioma Nwaiwu indicated no relevant financial relationships. Philip Dinh indicated no relevant financial relationships. Kavitha Subramanian indicated no relevant financial relationships. Philip Okafor indicated no relevant financial relationships.

P1320 (S0633). Development of a Stool Tool to Aid in Assessment of Diagnosis of GI Bleeding 1387892 Gabriela Kuftinec University of Miami, Jackson Memorial Hospital Development of a Stool Tool to Aid in Assessment of Diagnosis of GI Bleeding GI Bleeding ePoster Session Jonathan Steinberg, MD, MA1, Daniel A. Sussman, MD, MSPH2, Gabriela Kuftinec, MD, MPH1; 1University of Miami, Jackson Memorial Hospital, Miami, FL; 2University of Miami Miller School of Medicine, Miami, FLIntroduction: An accurate description of stool color and consistency is critical to direct diagnostic testing and manage a suspected gastrointestinal bleed. Use of a visual aid for stool blood color improves both descriptive accuracy and correlates better with bleeding location than subjective description alone. However, the benefit of such a visual aid has not been well studied among health care professionals. The aim of our study was to evaluate effectiveness of a novel visual stool tool in improving accurate characterization of blood per rectum among nurses and physicians.Methods: After developing a tool based on GI physician input, we developed a picture-based survey with questions relating to stool color, texture, and type of bleed. We provided the visual stool tool to respondents and repeated questions relating to the same pictures. Sample photos of stool were chosen with consensus of all three study designers. We administered this electronically to GI fellows, attendings, medicine residents and nurses. We noted changes in responses of color or stool type. An additional question was asked using the Bristol Stool Scale to determine if use of that visual aid changed responses. We also tested subjects for Red-Green colorblindness.Results: Of 64 responses to our surveys, 14 were GI fellows, 11 GI attendings, 35 medicine residents, 4 nurses. 86% correctly identified melena, 84% hematochezia and 89% BRPBR prior to access to the tool, and 97% correctly identified melena, 94% hematochezia and 92% BPBPR after exposure to the tool. Of those that identified correctly only after use of the visual aid, responses changed mostly from one description of bleeding (hematochezia) to correct description (melena). 100% correctly identified normal stool while without the tool, 98% with the tool. 1.6% were colorblind. Perceptions of the color wheel were largely positive, with 77% respondents noting the tool would help to manage a GI bleed.Discussion: Rapid identification of stool color is paramount to localization of a GI bleed. Gastroenterologists often rely on medicine and nursing colleagues to assist in the assessment, and we therefore attempt to create a tool to aid in correct and rapid identification of stool color. While our sample size remains small, we note favorable responses in correct identification of different types of GI bleeds. We plan to continue to test the tool with other health care professionals to allow improved communication to the gastroenterologist and improve patient care.Stool Color WheelDisclosures:Jonathan Steinberg indicated no relevant financial relationships. Daniel Sussman indicated no relevant financial relationships. Gabriela Kuftinec indicated no relevant financial relationships.

P1460 (S0655). The Incremental Rate of Thromboembolic Events in Patients With Inflammatory Bowel Disease Compared to Patients Without Immune-Mediated Diseases 1389079 Andres Yarur Medical College of Wisconsin The Incremental Rate of Thromboembolic Events in Patients With Inflammatory Bowel Disease Compared to Patients Without Immune-Mediated Diseases IBD ePoster Session Award: Presidential Poster AwardAndres Yarur, MD1, Juliana Setyawan, PharmD, MS2, Fan Mu, ScD, MS3, Miriam L. Zichlin, MPH3, Catherine Fernan3, Emma Billmyer3, Nathaniel Downes3, Hongbo Yang, PhD3, Nassir Azimi, PhD4; 1Medical College of Wisconsin, Milwaukee, WI; 2Arena Pharmaceuticals, San Diego, CA; 3Analysis Group, Inc., Boston, MA; 4Sharp Grossmont Hospital, La Mesa, CAIntroduction: This study systematically assessed the incremental risk of thromboembolic events among inflammatory bowel diseases (IBD) patients in the current era where the management of IBD has changed dramatically and several novel IBD agents have been approved. Such an assessment will also serve as a baseline reference for newer agents, such as JAK inhibitors.Methods: Adult patients with ≥ 2 diagnoses for IBD were identified from the IBM MarketScan Commercial and Medicare-Supplemental Claims database (2014-2018) and matched 1:1 on age, sex, and index year to patients without any immune-mediated diseases (IMD). The outcomes were thromboembolic events (venous: deep vein thrombosis [DVT] and pulmonary embolism [PE]; arterial: myocardial infarction [MI] and ischemic stroke [IS]). To include patients at various stages of IBD disease severity, the index date was the day after a randomly selected IBD medical claim for patients with IBD, and the day after a randomly selected medical claim for patients without IMD. The baseline period was 1-year period prior to the index date, and the study period was the period from index to the end of continuous follow-up (up to 4 years). Multivariable regressions adjusted for age, sex, baseline comorbidities, baseline medications excluding those for IBD, and baseline thromboembolic event of interest.Results: A total of 34,687 matched pairs (mean age 49.0 years, 54.4% female) were included. Patients with IBD generally had higher proportions of comorbidities compared to patients without IMD (e.g., Charlson comorbidity index [0.7 v 0.4]; cardiovascular disease [44.6% v 42.2%]; both p< 0.0001). A significantly higher proportion of patients with IBD had a baseline thromboembolic event compared to patients without IMD (4.7% v 2.6%, p< 0.0001). Patients with IBD experienced higher rates of venous thromboembolic events compared to patients without IMD (Table 1: adjusted incidence rate ratios (IRRs): 2.44 for DVT, 1.90 for PE; both p < 0.0001). Such increased rates were not observed for the arterial events (Table 1: adjusted IRRs: 1.15 for IS, 0.62 for MI).Discussion: Patients with IBD had significantly increased rates of DVT and PE compared to patients without IMD. Increased rates were not observed for IS and MI. This elevated risk should be carefully considered when managing patients with IBD, and the association between IMD treatments and elevated risk of thromboembolic events merits further investigation.Disclosures:Andres Yarur: Arena Pharmaceuticals – Consultant. Prometheus Bioscience – Consultant. Takeda – Consultant.Juliana Setyawan: Arena Pharmaceuticals – Employee.Fan Mu: Analysis Group Inc – Employee, Employee of Analysis Group, Inc., which received consultancy fees from Arena Pharmaceuticals.Miriam Zichlin: Analysis Group Inc – Employee, Employee of Analysis Group, Inc., which received consultancy fees from Arena Pharmaceuticals.Catherine Fernan: Analysis Group Inc – Employee, Employee of Analysis Group, Inc., which received consultancy fees from Arena Pharmaceuticals.Emma Billmyer: Analysis Group Inc – Employee, Employee of Analysis Group, Inc., which received consultancy fees from Arena Pharmaceuticals.Nathaniel Downes: Analysis Group Inc – Employee, Employee of Analysis Group, Inc., which received consultancy fees from Arena Pharmaceuticals.Hongbo Yang: Analysis Group Inc – Employee, Employee of Analysis Group, Inc., which received consultancy fees from Arena Pharmaceuticals.Nassir Azimi: Arena Pharmaceuticals – Other Financial or Material Support, a member of the Delphi panel for Arena Pharmaceuticals. Astra Zeneca – Speaker's Bureau. Daiichi Sankyo – Advisory Committee/Board Member, Speaker's Bureau. Gilead – Advisory Committee/Board Member, Speaker's Bureau. Janssen – Advisory Committee/Board Member, Speaker's Bureau.

P1470 (S0665). Clostridium difficile Infection in Patients With Ulcerative Colitis Treated With Tofacitinib in the Ulcerative Colitis Program: An Update as of May 2019 1387834 Edward Loftus Mayo Clinic College of Medicine Clostridium difficile Infection in Patients With Ulcerative Colitis Treated With Tofacitinib in the Ulcerative Colitis Program: An Update as of May 2019 IBD ePoster Session Edward V. Loftus, Jr., MD, FACG1, Alessandro Armuzzi2, Daniel C. Baumgart, MD, PhD, MBA, FRCP (Lon)3, Jeffrey R. Curtis, MD, MS, MPH4, Jami A. Kinnucan, MD5, Nana Koram, PhD, MPH6, Leonardo Salese, MD7, Chinyu Su, MD7, Kenneth Kwok, MS6, John C. Woolcott, PhD7; 1Mayo Clinic College of Medicine, Rochester, MN; 2Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Lazio, Italy; 3University of Alberta, Edmonton, AB, Canada; 4University of Alabama, Birmingham, AL; 5University of Michigan Medicine, Ann Arbor, MI; 6Pfizer Inc., New York, NY; 7Pfizer Inc., Collegeville, PAIntroduction: Tofacitinib is an oral, small molecule JAK inhibitor for the treatment of UC. Patients (pts) with UC are susceptible to C. difficile infection (CDI) [1]. In the tofacitinib UC clinical program, previous analyses showed CDI rates among tofacitinib-treated pts to be similar or numerically lower than placebo (PBO)-treated pts and pts treated with immunomodulators and TNFi in a generally comparable claims-based observational cohort [2]. Here, we present an updated analysis of CDI in the tofacitinib UC clinical program.Methods: CDI events were evaluated from 4 randomized, PBO-controlled studies (Phase [P]2 and P3 induction studies [NCT00787202; NCT01465763; NCT01458951]; 1 maintenance P3 study [NCT01458574]) and an ongoing, open-label, long-term extension (OLE) study (NCT01470612). 3 cohorts were analyzed: Induction (P2/P3 induction studies), Maintenance (P3 maintenance study) and Overall (pts receiving tofacitinib 5 or 10 mg twice daily [BID] in P2, P3 or OLE studies; analyzed by pts receiving ≥ 1 dose of tofacitinib and predominant dose [PD; 5 or 10 mg BID based on average daily dose < 15 mg or ≥ 15 mg, respectively]; data as of May 2019, database not locked). Proportions and incidence rates (unique pts with events per 100 pt-yrs [PY] of exposure) of CDI were evaluated. All pts underwent CDI screening; a positive test excluded pts from program entry.Results: The Overall Cohort comprised 1,157 pts who received ≥ 1 dose of tofacitinib 5 or 10 mg BID, representing 2,581 PY of tofacitinib exposure and up to 6.8 yrs of treatment. CDI occurred in 3 pts in the Induction Cohort (PBO, n=1; tofacitinib 10 mg BID, n=2), 3 pts in the Maintenance Cohort (PBO, n=3; CDI occurred 68, 81 and 98 days following initiation of PBO) and 9 pts in the Overall Cohort (PD tofacitinib 10 mg BID, n=9; Table). Overall Cohort pts with CDI were mild (n=4) or moderate (n=5) in severity; 6 pts continued study treatment without interruption, 1 temporarily discontinued and 2 permanently discontinued. CDI resolved with treatment in 8 pts and CDI was still present in 1 pt at the time of study discontinuation. Two events were reported as serious AEs due to hospitalization.Discussion: In the tofacitinib UC program, CDI rates among pts receiving tofacitinib have remained stable since the previous data cut [2] and are comparable to those reported for other advanced therapies [3].Rahier et al. J Crohns Colitis 2014;8:443-68.Loftus Jr. et al. Am J Gastroenterol 2019;114(S):P035.Ng et al. Inflamm Bowel Dis 2018;24:2431-41.Disclosures:Edward Loftus: AbbVie – Consultant, Grant/Research Support. Allergan – Consultant. Amgen – Consultant, Grant/Research Support. Boehringer Ingelheim – Consultant. Bristol-Myers Squibb – Consultant. Celgene – Consultant, Grant/Research Support. Celltrion – Consultant. Eli Lilly – Consultant. Exact Sciences – Consultant. Genentech – Consultant, Grant/Research Support. Gilead – Consultant. Janssen – Consultant. Pfizer Inc – Consultant. Robarts Clinical Trials – Grant/Research Support. Takeda – Consultant. UCB – Consultant.Alessandro Armuzzi: AbbVie – Consultant, Speaker's Bureau. Allergan – Consultant, Speaker's Bureau. Amgen – Consultant, Speaker's Bureau. AstraZeneca – Speaker's Bureau. Biogen – Consultant, Speaker's Bureau. Bristol-Myers Squibb – Consultant, Speaker's Bureau. Celgene – Consultant, Speaker's Bureau. Celltrion – Consultant, Speaker's Bureau. Chiesi – Speaker's Bureau. Eli Lilly – Consultant, Speaker's Bureau. Ferring – Consultant, Speaker's Bureau. Hospira – Consultant, Speaker's Bureau. Janssen – Consultant, Speaker's Bureau. Mitsubishi Tanabe Pharma – Speaker's Bureau. MSD – Consultant, Grant/Research Support, Speaker's Bureau. Mundipharma – Consultant, Speaker's Bureau. Mylan – Consultant, Speaker's Bureau. Nikkiso – Speaker's Bureau. Otsuka – Speaker's Bureau. Pfizer Inc – Consultant, Grant/Research Support, Speaker's Bureau. Roche – Consultant, Speaker's Bureau. Samsung Bioepis – Consultant, Speaker's Bureau. Sandoz – Consultant, Speaker's Bureau. Sofar – Consultant, Speaker's Bureau. Takeda – Consultant, Grant/Research Support, Speaker's Bureau. TiGenix – Speaker's Bureau. Zambon – Speaker's Bureau.Daniel Baumgart: AbbVie – Advisory Committee/Board Member. Gilead – Advisory Committee/Board Member. Janssen – Advisory Committee/Board Member. Nextbiotix – Advisory Committee/Board Member. Pfizer Inc – Advisory Committee/Board Member. Takeda – Advisory Committee/Board Member. University of Alberta – Consultant, The consultancy fees were paid to the University of Alberta.Jeffrey Curtis: Pfizer Inc – Consultant, Grant/Research Support.Jami Kinnucan: Pfizer Inc – Advisory Committee/Board Member.Nana Koram: Pfizer Inc – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Leonardo Salese: Pfizer Inc – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Chinyu Su: Pfizer Inc – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Kenneth Kwok: Pfizer Inc – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).John Woolcott: Pfizer Inc – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).

P1480 (S0675). Increased Risk of Ischemic Heart Disease in Inflammatory Bowel Disease Is Attenuated by Anti-TNF Therapy: A Population-Based Study 1389304 George Khoudari Cleveland Clinic Foundation Increased Risk of Ischemic Heart Disease in Inflammatory Bowel Disease Is Attenuated by Anti-TNF Therapy: A Population-Based Study IBD ePoster Session George Khoudari, MD1, Emad Mansoor, MD2, Ahmed Eltelbany, MD, MPH1, Mariam N. Rana, MD2, Sadeer Al-Kindi, MD2, Preetika Sinh, MD3, Jeffry Katz, MD4, Gregory Cooper, MD2, Miguel Regueiro, MD1; 1Cleveland Clinic Foundation, Cleveland, OH; 2University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH; 3Medical college of Wisconsin, Milwaukee, WI; 4University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OHIntroduction: Patients with inflammatory bowel disease (IBD) are at increased risk of ischemic heart disease (IHD). In Rheumatoid arthritis patients, Anti-Tumor Necrosis Factor (TNF) therapy has been shown to be protective against IHD. In IBD, the association between anti-TNF use and IHD is less clear. We sought to investigate the prevalence of IHD in IBD patients with and without anti-TNF therapy.Methods: We used a commercial database (Explorys Inc, Cleveland, OH), which includes electronic health record data from 26 major integrated US healthcare systems from 2000 to 2019. Using Systematized Nomenclature of Medicine Clinical Terms, we identified all patients (age >18 years) with UC. The primary outcome was to evaluate the prevalence of UC colectomy and biologic utilization over 2 decades as well as compare these rates with linear regression. The biologic group included anti-TNFs, anti-integrin, and anti-IL12,23.Results: Of the 32,338,660 individuals in the database from 2015 to present, we identified 139,710 (0.4%) patients with CD and 114,770 (0.3%) patients with UC, of whom 24,160 (17%) and 8,080 (7%) patients received anti-TNFs, respectively. The prevalence of IHD was 11.5% and 9.7% for CD and UC, respectively, compared to 4.5% in individuals without IBD, p< 0.001, respectively. The prevalence of IHD was significantly lower in anti-TNFs-treated CD patients (2.5%) compared to those who did not receive anti-TNFs (13%). Similarly, anti-TNF-treated UC patients were significantly less likely to have IHD (2.5%) compared to UC patients who did not receive anti-TNF therapy (10.5%). [CD OR: 0.17, 95% CI: 0.16-0.19, p< 0.001; UC OR: 0.22, 95% CI: 0.19-0.25, p< 0.001].Discussion: In this large study, we found that IBD patients treated with anti-TNFs were significantly less likely to be diagnosed with IHD compared to IBD patients who were anti-TNF naive. Whether anti-TNFs have a cardio-protective effect related anti-inflammatory properties or a direct modifying effect in ischemic events is not clear.Figure 1: The prevalence of Ischemic Heart Disease in patients with inflammatory bowel disease with and without anti-TNF therapyTable 1: Anti-TNF characteristics of inflammatory bowel disease individuals with Ischemic Heart DiseaseDisclosures:George Khoudari indicated no relevant financial relationships. Emad Mansoor indicated no relevant financial relationships. Ahmed Eltelbany indicated no relevant financial relationships. Mariam Rana indicated no relevant financial relationships. Sadeer Al-Kindi indicated no relevant financial relationships. Preetika Sinh indicated no relevant financial relationships. Jeffry Katz indicated no relevant financial relationships. Gregory Cooper indicated no relevant financial relationships. Miguel Regueiro: Abbvie – Advisory Committee/Board Member, Consultant, Grant/Research Support. Janssen – Advisory Committee/Board Member, Consultant, Grant/Research Support. Pfizer – Advisory Committee/Board Member, Consultant, Grant/Research Support. Takeda – Advisory Committee/Board Member, Consultant, Grant/Research Support.

P1490 (S0685). Time Spent Caring for Inflammatory Bowel Disease Patients: Analysis of Office Visits From the National Ambulatory Medical Care Survey 1389102 Neil Nadpara Temple University Hospital Time Spent Caring for Inflammatory Bowel Disease Patients: Analysis of Office Visits From the National Ambulatory Medical Care Survey IBD ePoster Session Neil Nadpara, MD1, Yiting Li, MD2, Frank Friedenberg, MD, MS (Epi)1; 1Temple University Hospital, Philadelphia, PA; 2St. Francis Medical Center, Trenton, NJIntroduction: Successful clinical outcomes in Inflammatory Bowel Disease (IBD) requires strong rapport between patient and physician in the outpatient setting. With advances in EMR systems and changes to healthcare models, the dynamic of office visits has changed dramatically. Our aim was to examine trends in time spent with patients during IBD office visits in the United States from 2005-2015. Additionally, we analyzed this data based on demographics, type of IBD, and other relevant visit variables.Methods: The CDC National Ambulatory Medical Care Survey (NAMCS) uses weighted sampling methods to generate cross-sectional data representative of ambulatory care visits in the US. Using ICD-9 codes, we identified patients with IBD for the period 2005-2015. After review of boxplots, we selected office visits with time spent between 5-45 minutes (m). Weighting of encounters using SAS was performed to provide population estimates. The study period was divided into 4 groups for trend analysis. T-test or ANOVA were used for comparison of continuous variables and Chi-square test for categorical variables.Results: After weighting, there were 24.5 million IBD office visits from 2005-2015; CD 60.5% and UC 39.5%. The mean age was 49.0 ± 0.9y, ranging from 5-92y, 53.8% female and 46.2% male. Non-Hispanic white 85.5%, non-Hispanic black 7.5%, Hispanic and Asian 7.0%. The mean time spent for an IBD visit was 21.9 ± 0.60m. Significant differences in time spent were identified in the following comparisons: CD vs. UC (20.7m vs. 23.6m, p=0.02); dietary counseling given vs. not (28.8m vs. 20.4m, p < 0.0001); private insurance vs. Medicare and Medicaid (21.4m vs. 23.1m, p< 0.001). The average time spent on an IBD office visit has increased significantly from 2005 to 2015: 2003-2005:18.2 ± 1.1m, 2006-2008: 20.0 ± 0.8m, 2009-2011: 20.5 ± 1.1m, 2012-2014: 24.7 ± 0.8m (p < 0.0001 for trend).Discussion: The average time spent on IBD visits was around 4 mins longer compared to population estimates of primary care visits for other disorders. Time spent with UC patients was nearly 3 mins longer compared to CD patients, opposite of what we had predicted. Dietary counseling added the most time spent among variables. Time spent on IBD visits has trended up significantly from 2005 to 2015 in conjunction with the advent of EMRs and increased biologic options leading to expanded treatment algorithms. This data may be helpful for gastroenterologists in planning their patient schedules.Disclosures:Neil Nadpara indicated no relevant financial relationships. Yiting Li indicated no relevant financial relationships. Frank Friedenberg indicated no relevant financial relationships.

P1500 (S0695). Appropriateness of Medical and Surgical Treatments in Patients With Chronic Inflammation of the Ileal Pouch: A RAND Panel Approach 1389022 Gaurav Syal Cedars-Sinai Medical Center Appropriateness of Medical and Surgical Treatments in Patients With Chronic Inflammation of the Ileal Pouch: A RAND Panel Approach IBD ePoster Session Gaurav Syal, MD, MHDS1, Miles Sparrow, MD2, Fernando Velayos, MD, MPH3, Leonard Baidoo, MD4, Brian Bressler, MD, MS5, Adam Chiefetz, MD6, Shane Devlin, MD, FRCPC7, Jennifer Jones, MD8, Peter M. Irving, MD, MA, FRCP9, Gilaad Kaplan, MD, MPH7, Patricia Kozuch, MD10, Laura Raffals, MD, FACG11, Krisztina Gecse, MD, PhD12, Phillip Fleshner, MD1, Amy L. Lightner, MD13, Thomas Ullman, MD14, Corey A. Siegel, MD, MS15, Gil Y. Melmed, MD, MS1; 1Cedars-Sinai Medical Center, Los Angeles, CA; 2The Alfred Hospital, Melbourne, Victoria, Australia; 3Kaiser Permanente Medical Center, San Francisco, CA; 4Northwestern Memorial Hospital, Chicago, IL; 5University of British Columbia, Vancouver, BC, Canada; 6Beth Israel Deaconess Medical Center, Boston, MA; 7University of Calgary, Calgary, AB, Canada; 8Dalhousie University, Halifax, NS, Canada; 9Guy’s and St Thomas’ Hospital, London, England, United Kingdom; 10Thomas Jefferson University Hospital, Philadelphia, PA; 11Mayo Clinic, Rochester, MN; 12University of Amsterdam, Amsterdam, Noord-Holland, Netherlands; 13Cleveland Clinic Foundation, Cleveland, OH; 14Montefiore Medical Center, New York City, NY; 15Dartmouth-Hitchcock Medical Center, Hanover, NHIntroduction: The optimal treatment of chronic inflammatory pouch disorders remains a challenge due to the paucity of high-quality studies. We aimed to provide guidance for clinicians on the appropriateness of medical and surgical treatments in patients with these disorders.Methods: The appropriateness of medical and surgical treatments in patients with pouchitis was considered in 16 clinical scenarios incorporating pouchitis symptoms, antibiotic response, prepouch ileitis (PI) (extending >10 cm proximal to pouch inlet) and Crohn’s disease (CD)-like complications. Appropriateness of permanent ileostomy was considered in 8 additional scenarios. Using the RAND/UCLA modified Delphi method, 13 international inflammatory bowel diseases experts rated appropriateness of treatments on a 1-9 scale (1-3 inappropriate, 4-6 uncertain, 7-9 appropriate) via a web-based survey, then met to discuss and re-rate scenarios. Disagreement was assessed using a validated index; scenarios with disagreement were rated as uncertain.Results: Chronic antibiotic therapy was rated appropriate only in asymptomatic antibiotic-dependent patients with no CD-like complications and was otherwise inappropriate (Table 1). Ileal-release budesonide was rated appropriate in 6/16 (38%) scenarios including patients with extensive PI but no CD-like complications. Its use was considered inappropriate (5/8) or uncertain (3/8) in the presence of CD-like complications. Probiotics were considered inappropriate in 14/16 (88%) and uncertain in 2/16 (12%) scenarios. Biologic therapy was considered appropriate in 14/16 (88%) scenarios and uncertain in the absence of extensive PI or CD-like complications (12%). Permanent ileostomy was considered appropriate in 3/16 (19%) scenarios including symptomatic patients with extensive PPI and CD-like complications (Table 2). In patients refractory to all medical treatments, permanent ileostomy was considered appropriate in all scenarios except in asymptomatic patients with no CD-like complications.Discussion: In the presence of extensive PI or CD-like complications, chronic antibiotics and probiotics are inappropriate. Ileal-release budesonide is appropriate in patients who have chronic pouchitis with extensive PI but no CD-like complications. Biologic use is appropriate in patients with chronic pouchitis except in asymptomatic patients with no evidence of complications. Permanent ileostomy is appropriate in most patients who have failed all medical treatments.Table 1. Appropriateness of medical and surgical treatments in patients with chronic pouch inflammationTable 2. Appropriateness of a permanent ileostomy in patients with chronic pouch inflammation who have failed antibiotics, ileal release budesonide, probiotics and biologicsDisclosures:Gaurav Syal: Pfizer – Grant/Research Support.Miles Sparrow indicated no relevant financial relationships. Fernando Velayos indicated no relevant financial relationships. Leonard Baidoo indicated no relevant financial relationships. Brian Bressler: Abbvie – Consultant. BMS – Consultant. Celgene – Consultant. Ferring – Consultant. Genentech – Consultant. Gilead – Consultant. Janssen – Consultant. Merck – Consultant. Pfizer – Consultant. Takeda – Consultant, Speaker's Bureau.Adam Chiefetz: Abbvie – Consultant. arena – Consultant. Inform Diagnostics – Grant/Research Support. Jannsen – Consultant. Pfizer – Consultant. Prometheus – Consultant. Samsung – Consultant. Takeda – Consultant.Shane Devlin indicated no relevant financial relationships. Jennifer Jones indicated no relevant financial relationships. Peter Irving: Abbvie – Advisory Committee/Board Member. Janssen – Advisory Committee/Board Member, Speaker's Bureau. Pfizer – Advisory Committee/Board Member, Speaker's Bureau. Takeda – Advisory Committee/Board Member, Speaker's Bureau.Gilaad Kaplan: Abbvie – Speaker's Bureau. Ferring – Grant/Research Support. Janssen – Speaker's Bureau. Pfizer – Speaker's Bureau.Patricia Kozuch indicated no relevant financial relationships. Laura Raffals indicated no relevant financial relationships. Krisztina Gecse: Abbvie – Advisory Committee/Board Member. Ferring – Speaker's Bureau. Immunic AG – Advisory Committee/Board Member. Pfizer – Advisory Committee/Board Member, Speaker's Bureau. Samsung Bioepis – Advisory Committee/Board Member, Speaker's Bureau. Sandoz – Advisory Committee/Board Member. Takeda – Advisory Committee/Board Member, Speaker's Bureau. Tillotts – Speaker's Bureau.Phillip Fleshner: TAKEDA – Consultant.Amy Lightner: Takeda – Consultant.Thomas Ullman indicated no relevant financial relationships. Corey Siegel: abbvie – Consultant, Grant/Research Support, CME presentations. Jannsen – Consultant. Pfizer – Consultant, Grant/Research Support, CME presentations. Takeda – Consultant, Grant/Research Support, CME presentations.Gil Melmed: Boehringer-Ingelheim – Consultant. Bristol Meyers Squibb – Consultant. Janssen – Consultant. Medtronic – Consultant. Pfizer – Consultant. Takeda – Consultant. Techlab – Consultant.

P1510 (S0705). Evaluation of Symptom Improvement During Induction in Patients With Crohn’s Disease Treated With Mirikizumab 1390061 William Sandborn University of California San Diego Evaluation of Symptom Improvement During Induction in Patients With Crohn’s Disease Treated With Mirikizumab IBD ePoster Session Award: Presidential Poster AwardWilliam J. Sandborn, MD, FACG1, Bruce E. Sands, MD, MS, FACG2, Peter Hindryckx3, Monika Fischer, MD, MSc4, Kim Isaacs5, April N. Naegeli, DrPH, MPH6, Debra Miller6, Elisa Gomez Valderas6, Noah Agada6, Paul Pollack6, Geert D'Haens, MD, PhD7; 1University of California San Diego, La Jolla, CA; 2Icahn School of Medicine at Mount Sinai, New York, NY; 3University Hospital of Ghent, Ghent, Brussels Hoofdstedelijk Gewest, Belgium; 4Indiana University School of Medicine, Indianapolis, IN; 5University of North Carolina at Chapel Hill, Chapel Hill, NC; 6Eli Lilly and Company, Indianapolis, IN; 7Inflammatory Bowel Disease Centre, Academic Medical Centre, Amsterdam, Noord-Holland, NetherlandsIntroduction: Mirikizumab (miri), a humanized, IgG4 monoclonal antibody that targets IL23, has shown efficacy and safety in patients treated for Crohn’s disease (CD), psoriasis, and ulcerative colitis. In a phase 2, randomised, parallel-arm, placebo-controlled study, symptom improvement was evaluated in patients with moderately-to-severely active CD after intravenous induction treatment with miri (NCT02891226).Methods: Entry criteria for enrollment included an average daily stool frequency (SF; ≥ 4) and/or the average daily occurrence of abdominal pain (AP; ≥ 2) from the Crohn’s Disease Activity Index (CDAI), and a Simple Endoscopic Score for CD ≥ 7 in patients with ileal-colonic or ≥ 4 in patients with isolated ileal disease. Patients were randomised 2:1:1:2 to receive intravenous miri (200 mg, 600 mg, or 1,000 mg) or placebo at weeks 0, 4, and 8. Endpoints in this analysis included changes from baseline in CDAI, SF, and AP at weeks 4, 8, and 12. A mixed effects model for repeated measures analysis was conducted to compare mean changes from baseline across treatment groups for the all-patient cohort and for the biologic-experienced sub-group. Factors in the analysis included treatment, geographic region, baseline score, prior biologic CD therapy (all-patient cohort), visit, and treatment by visit interaction as fixed effects. An unstructured variance covariance was used.Results: A total of 191 patients were randomised at baseline, which included biologic naïve (n=71) and biologic-experienced patients (n=120). Changes in CDAI, SF, AP at weeks 4, 8 and 12 compared to baseline are shown in the Table. In the all-patient cohort, statistically significant improvement in CDAI was observed with miri 600 mg and in SF with miri 200 mg compared to placebo as early as week 4 (Table). Improvement in CDAI and SF occurred with all miri doses (200 mg, 600 mg, 1,000 mg) at weeks 8 and 12 and in AP at weeks 8 and 12 with all miri doses. Compared to placebo, the subgroup of biologic-experienced patients showed statistically significant improvement in CDAI at week 4 (miri 600 mg) and at weeks 8 and 12 with all three doses. Further, significant improvement was observed in SF at week 12 (miri 600 mg and miri 1,000 mg) and in AP at week 8 (miri 600 mg) and week 12 (miri 600 mg and miri 1,000 mg).Discussion: Treatment with miri induced early improvement in clinical symptoms and disease activity in patients with moderately-to-severely active CD.Disclosures:William Sandborn: Abbvie – Consultant, Grant/Research Support. Allergan – Consultant. Amgen – Consultant, Grant/Research Support. Atlantic Healthcare Limited – Grant/Research Support. Boehringer Ingelheim – Consultant. Celgene – Consultant, Grant/Research Support. Conatus – Consultant. Cosmo – Consultant. Eli Lilly and Company – Consultant, Grant/Research Support. Escalier Biosciences – Consultant, Stockholder/Ownership Interest (excluding diversified mutual funds). Ferring – Consultant. Genentech – Consultant, Grant/Research Support. Gilead – Consultant, Grant/Research Support. Janssen – Consultant, Grant/Research Support. Miraca Life Sciences – Consultant. Nivalis Therapeutics – Consultant. Novartis Nutrition Science Partners – Consultant. Oppilan Pharma – Consultant, Stockholder/Ownership Interest (excluding diversified mutual funds). Otsuka – Consultant. Paul Hastings – Consultant. Pfizer – Consultant. Precision IBD – Consultant, Stockholder/Ownership Interest (excluding diversified mutual funds). Progenity – Consultant, Stockholder/Ownership Interest (excluding diversified mutual funds). Prometheus Laboratories – Consultant. Ritter Pharmaceuticals – Consultant, Stockholder/Ownership Interest (excluding diversified mutual funds). Robarts Clinical Trials – Consultant. Salix – Consultant. Seres Therapeutics – Consultant. Shire – Consultant. Sigmoid Biotechnologies – Consultant. Takeda – Consultant, Grant/Research Support. Tigenix – Consultant. Tillotts Pharma – Consultant. UCB Pharma – Consultant. Vivelix – Consultant.Bruce Sands: 4D Pharma – Consultant. Abbvie – Consultant. Allergan Sales – Consultant. Amgen – Consultant. Arena Pharmaceuticals – Consultant. Boehringer Ingelheim – Consultant. Capella Biosciences – Consultant. Celgene – Consultant, Grant/Research Support. Eli Lilly and Company – Consultant. EnGene – Consultant. Ferring – Consultant. Gilead – Consultant. Janssen – Consultant, Grant/Research Support. Lyndra – Consultant. MedImmune – Consultant. Oppilan Pharma – Consultant. Otsuka – Consultant. Palatin Technologies – Consultant. Pfizer – Consultant, Grant/Research Support. Progenity – Consultant. Rheos Medicines – Consultant. Seres Therapeutics – Consultant. Synergy Pharmaceuticals – Consultant. Takeda – Consultant, Grant/Research Support. Target PharmaSolutions – Consultant. Theravance Biopharma R&D – Consultant. TiGenix – Consultant. Vivelix Pharmaceuticals – Consultant. WebMD – Consultant.Peter Hindryckx: Abbvie – Consultant, Speaker's Bureau. Chiesi – Speaker's Bureau. Falk Pharma – Speaker's Bureau. Ferring – Speaker's Bureau. Takeda – Consultant, Speaker's Bureau. Tillotts Pharma – Speaker's Bureau. Vifor Pharma – Speaker's Bureau.Monika Fischer: Finch Therapeutics Group – Consultant. Rebiotix – Other Financial or Material Support, DSMB member.Kim Isaacs: Abbvie – Grant/Research Support, Other Financial or Material Support, Fellowship training support. Celgene – Grant/Research Support. Eli Lilly and Company – Grant/Research Support. Janssen – Grant/Research Support, Other Financial or Material Support, DSMB member. Medimmune – Other Financial or Material Support, DSMB member. Pfizer – Other Financial or Material Support, Fellowship training support. Roche – Grant/Research Support. Takeda – Grant/Research Support, Other Financial or Material Support, Fellowship training support. UCB – Grant/Research Support.April Naegeli: Eli Lilly and Company – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Debra Miller: Eli Lilly and Company – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Elisa Gomez Valderas: Eli Lilly and Company – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Noah Agada: Eli Lilly and Company – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Paul Pollack: Eli Lilly and Company – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Geert D''Haens: AbbVie – Advisory Committee/Board Member. Ablynx – Advisory Committee/Board Member. Allergan – Advisory Committee/Board Member. Alphabiomics – Advisory Committee/Board Member. AM Pharma – Advisory Committee/Board Member. Amakem – Advisory Committee/Board Member. Amgen – Advisory Committee/Board Member. Arena Pharmaceuticals – Advisory Committee/Board Member. AstraZeneca – Consultant. Avaxia – Advisory Committee/Board Member. Biogen – Advisory Committee/Board Member. Boehringer Ingelheim – Advisory Committee/Board Member. Bristol-Myers Squibb – Advisory Committee/Board Member. Celgene/Receptos – Advisory Committee/Board Member. Celltrion – Advisory Committee/Board Member. Cosmo – Advisory Committee/Board Member. Dr Falk Pharma – Advisory Committee/Board Member. Echo Pharmaceuticals – Consultant. Eli Lilly and Company – Advisory Committee/Board Member. Engene – Advisory Committee/Board Member. Ferring – Advisory Committee/Board Member. Galapagos – Advisory Committee/Board Member. Genentech/Roche – Advisory Committee/Board Member. Gilead – Advisory Committee/Board Member. GlaxoSmithKline – Advisory Committee/Board Member. Gossamerbio – Advisory Committee/Board Member. Hospira/Pfizer – Advisory Committee/Board Member. Immunic – Advisory Committee/Board Member. Johnson and Johnson – Advisory Committee/Board Member. Kintai Therapeutics – Advisory Committee/Board Member. Lycera – Advisory Committee/Board Member. Medimetrics – Advisory Committee/Board Member. Medtronics – Advisory Committee/Board Member. Merck Sharp Dome – Advisory Committee/Board Member. Millenium/Takeda – Advisory Committee/Board Member. Mitsubishi Pharma – Advisory Committee/Board Member. Mundipharma – Advisory Committee/Board Member. Nextbiotics – Advisory Committee/Board Member. Novo Nordisk – Advisory Committee/Board Member. Otsuka – Advisory Committee/Board Member. Pfizer/Hospira – Advisory Committee/Board Member. Photopill – Advisory Committee/Board Member. Prodigest – Advisory Committee/Board Member. Progenity – Advisory Committee/Board Member. Prometheus Laboratories/Nestle – Advisory Committee/Board Member. Protagonist – Advisory Committee/Board Member. RedHill – Advisory Committee/Board Member. Robarts Clinical Trials – Advisory Committee/Board Member. Salix – Advisory Committee/Board Member. Samsung Bioepis – Advisory Committee/Board Member. Sandoz – Advisory Committee/Board Member. Seres/Nestle – Advisory Committee/Board Member. Setpoint – Advisory Committee/Board Member. Shire – Advisory Committee/Board Member. Teva – Advisory Committee/Board Member. Tigenix – Advisory Committee/Board Member. Tillotts – Advisory Committee/Board Member. Topivert – Advisory Committee/Board Member. Versant – Advisory Committee/Board Member. Vifor – Advisory Committee/Board Member.

P1520 (S0715). Longer Duration of Response With Proactive Therapeutic Drug Monitoring for Infliximab but Not for Vedolizumab Treatment in Patients With Inflammatory Bowel Disease 1388677 Sarmed Al Yassin Virginia Commowealth University Health System Longer Duration of Response With Proactive Therapeutic Drug Monitoring for Infliximab but Not for Vedolizumab Treatment in Patients With Inflammatory Bowel Disease IBD ePoster Session Sarmed Al Yassin, MD1, Joseph Spataro, MD1, Le Kang, PhD1, Jill Gaidos, MD, FACG2; 1Virginia Commonwealth University, Richmond, VA; 2Virginia Commonwealth University Health System / McGuire VA Medical Center, Richmond, VAIntroduction: Therapeutic drug monitoring (TDM) assesses drug concentration and anti-drug antibodies at a certain treatment timepoint. TDM potentially minimizes unfavorable outcomes, determines loss of response, and aids in targeting a therapeutic drug level to maximize clinical effect. TDM is either performed reactively in response to disease activity or proactively in the absence of symptoms. The aim of this study is to compare outcomes of proactive, reactive and no TDM in IBD patients receiving Infliximab or Vedolizumab.Methods: After obtaining IRB approval, we performed a retrospective chart review of IBD veterans treated with Infliximab or Vedolizumab. All were seen in the outpatient Gastroenterology clinics at a single VA Medical Center from 1/1/14 to 12/1/19. Outcomes were followed through 4/10/20. Data collected included demographics, details of the IBD history, and disease activity scores at the time of TDM. Therapeutic outcomes included drug discontinuation, IBD-related surgery, hospitalization, or corticosteroid use.Results: 67 Veterans with IBD were included: 43 treated with Infliximab (Table 1) and 24 with Vedolizumab (Table 2). In subjects who received Infliximab, those monitored proactively were more likely to have a therapeutic drug level (p=0.0008) and less likely to have detectable drug antibodies (p=0.0002) at the first TDM check (Table 3). Subsequent TDM did not significantly impact adverse outcomes.The mean duration to adverse outcomes was lower in the reactive compared to the proactive cohort (25 weeks vs 104 weeks) but did not reach statistical significance.Subjects on Vedolizumab who were proactively monitored were more likely to have a therapeutic drug level compared to the reactive TDM cohort (p=0.0001) at the first TDM check only. However, the percentage of those with detected antibodies, total and mean duration to an adverse outcome were not significantly different.Discussion: In this single-center retrospective study, proactive TDM was associated with therapeutic drug levels and a lower likelihood of having detectable antibody levels at the 1st check, leading to a clinically significant longer duration of Infliximab treatment. The incidence of adverse events was low regardless of TDM with Vedolizumab use. While our results suggest it is better to optimize Infliximab therapy early, prior to an undesirable outcome, the benefits of TDM with Vedolizumab use is yet to be determined.Table 1. Subject Characteristics with Inflammatory Bowel Disease Receiving Infliximab TherapyTable 2. Subject Characteristics with Inflammatory Bowel Disease Receiving Vedoluzimab TherapyTable 3. TDM Characteristics and Adverse Outcomes in Subjects on Infliximab and Vedolizumab TreatmentDisclosures:Sarmed Al Yassin indicated no relevant financial relationships. Joseph Spataro indicated no relevant financial relationships. Le Kang indicated no relevant financial relationships. Jill Gaidos indicated no relevant financial relationships.

P1530 (S0725). Impact of Infliximab-dyyb (Infliximab Biosimilar) on Clinical and Patient-Reported Outcomes: 1-Year Follow-Up Results From an Observational Real World Study Among Patients With Inflammatory Bowel Disease (ONWARD Study) 1389178 Bincy Abraham Houston Methodist Hospital Impact of Infliximab-dyyb (Infliximab Biosimilar) on Clinical and Patient-Reported Outcomes: 1-Year Follow-Up Results From an Observational Real World Study Among Patients With Inflammatory Bowel Disease (ONWARD Study) IBD ePoster Session Bincy P. Abraham, MD, MS1, Bertus Eksteen, MBChB, FRCP, PhD2, Khan Nedd, MD3, Hrishikesh P. Kale, MS, PhD4, Dipen Patel, PhD4, Jennifer Stephens, PharmD, BCPS4, Ahmed Shelbaya, MD, MSc, MPH5, Richard Chambers, MSPH6, Arif Soonasra, PharmD6; 1Houston Methodist Hospital, Houston, TX; 2Aspen Woods Clinic, Calgary, AB, Canada; 3Infusion Associates, Grand Rapids, MI; 4Pharmerit International LP, Bethesda, MD; 5Columbia University/Pfizer Inc., Brooklyn, NY; 6Pfizer Inc., Collegeville, PAIntroduction: The objective of this study was to describe the effects of infliximab-dyyb, a biosimilar to reference product (RP) infliximab, on clinical and patient-reported outcomes (PROs) in inflammatory bowel disease (IBD) including Crohn’s disease (CD) and ulcerative colitis (UC) patients in a real-world setting.Methods: In this prospective, observational study, patients with IBD in the US and Canada were recruited to begin treatment with infliximab-dyyb. Patients, divided into biological naive users of infliximab-dyyb (naive users) and those switching from RP infliximab to infliximab-dyyb, were followed for 1 year. Clinical outcomes assessed were partial Mayo score (PMS) and Harvey Bradshaw Index (HBI) for the UC and CD cohort, respectively. Clinical response (PMS/HBI reduction ≥3 points) and remission (PMS < 3 or HBI < 5) were measured. Patient reported outcomes (PROs) included: Short Inflammatory Bowel Disease Questionnaire (SIBDQ) and EuroQol Visual Analog Scale (EQ-VAS). Changes from baseline were assessed using mixed models for repeated measures. Adverse events (overall/treatment-related) were assessed.Results: A total of 67 CD and 48 UC patients initiating treatment with infliximab-dyyb were enrolled (51% female; mean age 44 years; 87% Caucasian; mean BMI 27.9). Of them, 39 patients were naive users, 57 were switched from RP infliximab, and 19 were switched from other biologics. Among UC naïve users, PMS improved (p < .0001) and remission rate increased from baseline (p = 0.0015; Table 1). For UC patients switching from RP infliximab to infliximab-dyyb, PMS improved from baseline (p =0.0103; Table 1). CD naive users and patients switching from RP infliximab had low baseline HBI scores which where maintained over time (Table 2). Among all naïve users, SIBDQ and EQ-VAS scores improved from baseline (p< .0001 and 0.0135; Table 3). Patients switching from RP infliximab maintained SIBDQ and EQ-VAS scores (p = 0.1416 and 0.0675; Table 3). Regarding adverse events, 22 occurred related to treatment (including 5 lack of response, 4 infusion reaction, 2 immunogenicity, and 2 hypersensitivity reaction). Overall, 19 (17%) patients discontinued infliximab-dyyb.Discussion: Clinical outcomes among naive users of infliximab-dyyb improved for UC and were maintained for CD patients. Naive users of infliximab-dyyb showed significant improvements in PROs. Patients switching from RP infliximab to infliximab-dyyb maintained their clinical outcomes and quality of life.Disclosures:Bincy Abraham: Janssen – Consultant, Speaker's Bureau. Pfizer – Consultant, Speaker's Bureau.Bertus Eksteen indicated no relevant financial relationships. Khan Nedd: Infusion Associates – Other Financial or Material Support, Received funding from Pfizer.Hrishikesh Kale: Pharmerit International – Consultant, Employee of Pharmerit and received research funding from Pfizer.Dipen Patel: Pharmerit International – Consultant, Employee of Pharmerit and received research funding from Pfizer.Jennifer Stephens: Pharmerit International – Consultant, Employee of Pharmerit and received research funding from Pfizer.Ahmed Shelbaya: Pfizer – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Richard Chambers: Pfizer – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Arif Soonasra: Pfizer – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).

P1540 (S0735). Carriage of HLA-DQA1*05 in Hispanic IBD Patients Is Common and Also Associated With Development of Antibodies to Anti-TNFs but Not Other Biologics 1389925 Stephanie Ioannou University of Miami Miller School of Medicine Carriage of HLA-DQA1*05 in Hispanic IBD Patients Is Common and Also Associated With Development of Antibodies to Anti-TNFs but Not Other Biologics IBD ePoster Session Award: Presidential Poster AwardStephanie Ioannou, MD1, Ashley Beecham, PhD1, Lissette Gomez, MS1, Ryan Dauer, MD1, Maria Quintero, MPH1, Grechen Mills1, Joanna Lopez, MD2, James Leavitt, MD, FACG3, Norma Solis, MSN, ARNP1, Moriane Joseph, ARNP, MSN, MPH1, Glenda Quiñones, ARNP1, Amar Deshpande, MD1, David H. Kerman, MD1, Maria T. Abreu, MD1, Jacob McCauley, PhD1, Oriana M. Damas, MD1; 1University of Miami Miller School of Medicine, Miami, FL; 2Gastrohealth, PL, Miami, FL; 3Gastro Health, Miami, FLIntroduction: A prospective study of genetic factors linked to immunogenicity to the anti-TNFs has identified HLA-DQA1*05 in IBD patients. This specific HLA variant is carried by ~40% of Europeans. Limited studies exist examining the presence of this variant in Hispanic IBD populations. The aims of this study were to identify the frequency of HLA-DQA1*05 variants in a cohort of Hispanics with IBD and to determine the frequency of anti-drug antibody formation in HLA-DQA1*05 carriers treated with biologics.Methods: Adult patients who self-identified as Hispanic and provided consent for our IBD Biorepository were included.Whole-genome sequencing was performed at the Broad Institute and variants were called jointly using the Genome Analysis Toolkit (GATK) pipeline. The allele frequency of the HLA-DQA1*05 variant was examined in Hispanics. For patients carrying the HLA-DQA1*05 allele, the IBD database and electronic medical record were reviewed for IBD phenotype, biologic use, treatment duration, and biologic drug levels and antibody levels. A drug-binding antibody assay was used in all patients.Statistical analyses were done to determine the frequency of antibodies by biologic type, infliximab (IFX), adalimumab (ADA), vedolizumab (VDZ) and ustekinumab (UST).Results: A total of 714 Hispanics were sequenced and of these 248 (34.7%) had the HLA-DQA1*05 variant. There were 120 patients with available drug levels, and in these clinical and laboratory data was reviewed (Table 1 and 2). Most patients had Crohn’s disease (66.1%) and had ileocolonic disease. Average duration on biologic therapy was 2.4 years. A total of 30.8% of the 120 Hispanics had antibodies to biologic agents. Twenty-two of 85 patients (25.9%) on IFX developed antibodies and 18 of 50 patients (36%) on ADA developed antibodies. Only one of 18 patients on VDZ developed antibodies and no patients on UST developed antibodies (out of 8 patients). Further, development of drug antibodies in patients on monotherapy was seen in 15 (17.6%) patients on IFX, 15 (30%) patients on ADA and one (5.6%) patient on VDZ.Discussion: The results of our study suggest that HLA-DQA1*05 is seen in about a third of Hispanics with IBD, approaching the prevalence observed in Europeans. Carriage of HLA-DQA1*05 in Hispanics with IBD increases risk of antibody formation to anti-TNFs illustrating the clinical value of this polymorphism in Hispanics. We also demonstrate that the rate of immunogenicity with VDZ and UST is low even in the face of HLA-DQA1*05 carriage.Table 1. Patient DemographicsTable 2. Study ResultsDisclosures:Stephanie Ioannou indicated no relevant financial relationships. Ashley Beecham indicated no relevant financial relationships. Lissette Gomez indicated no relevant financial relationships. Ryan Dauer indicated no relevant financial relationships. Maria Quintero indicated no relevant financial relationships. Grechen Mills indicated no relevant financial relationships. Joanna Lopez: AbbVie, Inc. – Speaker's Bureau. Janssen Pharmaceuticals – Speaker's Bureau. Takeda Pharmaceuticals – Speaker's Bureau.James Leavitt indicated no relevant financial relationships. Norma Solis indicated no relevant financial relationships. Moriane Joseph indicated no relevant financial relationships. Glenda Quiñones indicated no relevant financial relationships. Amar Deshpande: ABIM – Advisory Committee/Board Member. GI Health Foundation – Advisory Committee/Board Member. Takeda Pharmaceuticals – Grant/Research Support.David Kerman: AbbVie, Inc. – Consultant. Academy for Continued Healthcare Learning – Employee. Cleveland Clinic – Consultant. PRIME Continue Medical Education – Employee.Maria Abreu: AbbVie, Inc. – Other Financial or Material Support. Allergan, Inc. – Other Financial or Material Support. Amgen, Inc. – Other Financial or Material Support. Boehringer Ingelheim Pharmaceuticals – Other Financial or Material Support. Celltrion Healthcare Co. LTD – Other Financial or Material Support. Cornerstones Health, Inc. – Other Financial or Material Support. Ferring Pharmaceuticals, Inc. – Other Financial or Material Support. Focus Medical Communications – Other Financial or Material Support. Gilead – Other Financial or Material Support. Imedex – Other Financial or Material Support. Janssen Pharmaceuticals – Other Financial or Material Support. Landos Biopharma – Other Financial or Material Support. Millennium Pharmaceuticals – Other Financial or Material Support. Pfizer, Inc. – Grant/Research Support. Prometheus Laboratories – Grant/Research Support. Seres Therapeutics, Inc. – Other Financial or Material Support. Shire – Other Financial or Material Support. Takeda Pharmaceuticals – Grant/Research Support. Theravance Biopharma, Inc. – Other Financial or Material Support. UCB Biopharma SRL – Other Financial or Material Support.Jacob McCauley indicated no relevant financial relationships. Oriana Damas: Pfizer Inc. – Grant/Research Support. Pfizer, Inc. – Advisory Committee/Board Member. PRIME Continuing Medical Education – Speaker's Bureau.

P1550 (S0745). Comparing Recurrence Rates of Clostridioides difficile Infection (CDI) for Patients With Inflammatory Bowel Disease After Long vs Short-Term Oral Vancomycin for Initial Episode of CDI 1389315 Ethan Berman Sidney Kimmel Medical College of Thomas Jefferson University Comparing Recurrence Rates of Clostridioides difficile Infection (CDI) for Patients With Inflammatory Bowel Disease After Long vs Short-Term Oral Vancomycin for Initial Episode of CDI IBD ePoster Session Ethan Berman, BS1, Bo Hyung Yoon, MD2, Amy Javia, MD2, Patricia Kozuch, MD2, Cuckoo Choudhary, MD2, Raina Shivashankar, MD2; 1Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA; 2Thomas Jefferson University Hospital, Philadelphia, PAIntroduction: Patients (pts) with IBD are at increased risk of Clostridioides difficile infection (CDI) and its associated morbidity and mortality. First line treatment (tx) of CDI is oral vancomycin (OV). Specific guidelines do not exist for CDI tx in IBD pts and studies have not definitively shown whether initial long-term OV reduces the rate of recurrent CDI (rCDI). This study compares rCDI rates following long-term OV versus short-term OV as tx for the first episode of CDI.Methods: We retrospectively reviewed 878 patient records in an existing database of IBD pts between 11/1/2016 and 2/28/2019 to identify those with a history (hx) of CDI. The following data was obtained: baseline demographics, tx of first CDI, and rCDI. Short-term OV was defined as 10-14 days of tx, and long-term OV was a taper of at least 4 weeks; the length of OV tx was based on physician discretion. Categorical variables were analyzed using the Chi-Square test.Results: 78 pts (8.9% of the total cohort, 57% female, median age 21 yrs [range 4-66] at IBD diagnosis) with hx of CDI were identified; 47 pts had data available to identify the prescribed antibiotic and the length of tx for their first CDI episode (Table 1). 24 pts (51%) had initial tx with short-term OV and 14 pts (30%) with a long-term OV. 4 pts in both the short-term and long-term OV groups received concomitant metronidazole (MTZ); thus a total of 8 pts received concomitant MTZ. The remaining 9 pts were treated with MTZ alone. 12 pts (50%) treated with short-term OV and 5 pts (36%) treated with long-term OV developed rCDI. rCDI in those with short-term OV was not significantly different from those with long-term OV (50% vs 36%, p=0.39); there was no difference between those with CD or UC (p=0.13 and 0.82, respectively) in terms of tx length and rCDI. Smoking (OR = 0.70, 95% CI [0.15 – 3.07], p=0.59) was not associated with increased odds of rCDI. Long-term OV (OR=0.59 [0.13-2.52], p=0.42) and concomitant use of MTZ (OR=0.33 [0.03-2.34], p=0.21) were not associated with decreased odds of rCDI (Table 2).Discussion: In pts with available antibiotic data, our study shows that there was no difference in rCDI following short-term OV and long-term OV as tx for the first episode of CDI; this may have been due to a small sample size as there was a lower percentage of rCDI in those with long-term OV. Long-term OV or concomitant MTZ did not decrease odds of rCDI. Further prospective study in a larger cohort of pts is warranted to validate these findings.Demographic Data and Clostridioides difficile Recurrence DataStatistical AnalysisDisclosures:Ethan Berman indicated no relevant financial relationships. Bo Hyung Yoon indicated no relevant financial relationships. Amy Javia indicated no relevant financial relationships. Patricia Kozuch indicated no relevant financial relationships. Cuckoo Choudhary indicated no relevant financial relationships. Raina Shivashankar indicated no relevant financial relationships.

P1570 (S0765). Infliximab Biosimilar Use for Inflammatory Bowel Disease: A National Veterans Affairs Experience 1389547 Jessica Johnson Academic Medical Center Infliximab Biosimilar Use for Inflammatory Bowel Disease: A National Veterans Affairs Experience IBD ePoster Session Jessica Johnson, MD, MS1, Andrew J. Gawron, MD, PhD2, Jeffrey R. Curtis, MD, MS, MPH3, Derek K. Pinnell, PharmD4, Wei Chen, MS2, Shaobo Pei, PhD2, Jorge Rojas, Jr., MS5, Joshua F. Baker, MD, MSCE6, Brian Sauer, PhD, MS1, Vicki Star, MD7, David Wu, PhD8, Jessica A. Walsh9; 1Academic Medical Center, Salt Lake City, UT; 2University of Utah, Salt Lake City, UT; 3University of Alabama, Birmingham, AL; 4Salt Lake City Veterans Affairs, Lehi, UT; 5VA Puget Sound Healthcare System, Seattle, WA; 6University of Pennsylvania, Philadelphia, PA; 7Merck & Co., North Wales, PA; 8Merck & Co., Rahway, NJ; 9Salt Lake City Veterans Affairs, Salt Lake City, UTIntroduction: This study described real world use of infliximab (IFX) products for Inflammatory Bowel Disease (IBD), within the context of Veterans Affairs National Formulary (VANF) Policy. IFX products included the IFX originator (IFX-orig) and biosimilars (IFX-dyyb, IFX-abda). FX-orig was replaced by IFX-dyyb as the preferred IFX product on the VANF in May 2017, and IFX-dyyb was replaced by IFX-abda in September 2018. Per policy, Veterans with prior IFX experience may continue using the non-formulary product, but IFX naïve initiators are directed to select the VANF product. The purpose of this study was to describe IFX product selection for Crohn’s Disease (CD) and Ulcerative Colitis (UC) during the time frame when biosimilars entered the VA and obtained VANF status. The secondary purpose was to describe IFX product use during the 1st six months of study follow-up.Methods: Data sources included national electronic health record and administrative datasets generated from routine clinical care in the US. From 1/1/2016 to 12/31/2019, Veterans were included in the study upon receipt of their first IFX product. Eligible participants had a diagnosis code for UC or CD and had entered the VA >365 days prior to their index treatment. Monthly and annual IFX product selection was described for IFX-naïve and IFX-experienced patients. Frequency, proportions and 95% CIs were used to describe IBD cohort characteristics and initial IFX product selection during the study period.Results: IFX products were used in 3204 Veterans with IBD (60.2% CD, 39.8 UC). The mean age was 52.5 and 90% were male (Table 1). Non-formulary use of IFX-orig occurred in higher percentage of IFX experienced patients than IFX-naïve patients (Table 2). Product selection reflected VANF, with the highest frequencies of IFX-orig in 2016-17, IFX-dyyb during 2018, and IFX-abda during 2019. The time delay between the initial designation as the preferred IFX product and becoming the most frequently used IFX product in IFX-naïve Veterans was 5 months for IFX-dyyb and 2 months for IFX-abda (Figure 1).Discussion: Adoption of the initial biosimilar added to VANF in May 2017 was slower than adoption of the Sept. 2018 formulary change. Additional work is needed to understand utilization patterns with IFX biosimilars vs non-formulary IFX products and reasons for delay in formulary compliance. Assessment of ongoing product use will provide important details on how VANF influences IFX use in patients with and without prior IFX experience.Disclosures:Jessica Johnson indicated no relevant financial relationships. Andrew Gawron indicated no relevant financial relationships. Jeffrey Curtis: AbbVie – Consultant, Grant/Research Support. Amgen – Consultant, Grant/Research Support. BMS – Consultant, Grant/Research Support. Corrona – Consultant, Grant/Research Support. Eli Lilly – Consultant, Grant/Research Support. Janssen – Consultant, Grant/Research Support. Myriad – Consultant, Grant/Research Support. Pfizer – Consultant, Grant/Research Support. Regeneron – Consultant, Grant/Research Support. Roche – Consultant, Grant/Research Support. UCB – Consultant, Grant/Research Support.Derek Pinnell indicated no relevant financial relationships. Wei Chen: Merck – Other Financial or Material Support, This study is partially funded by Merck..Shaobo Pei indicated no relevant financial relationships. Jorge Rojas indicated no relevant financial relationships. Joshua Baker: Bristol-Myers Squib – Consultant. Gilead – Consultant.Brian Sauer: Merck – Other Financial or Material Support, Project was partially funded by Merck.Vicki Star: Merck & Co – Employee.David Wu: Merck & Co – Employee.Jessica Walsh: AbbVie – Consultant, Grant/Research Support. Amgen – Consultant. Lilly – Consultant. Novartis – Consultant. Pfizer – Consultant. Pfizer – Grant/Research Support. UCB – Consultant.

P1580 (S0775). The Transition of the J-Pouch Phenotype in Inflammatory Bowel Disease Patients With Cuffitis 1389010 Shintaro Akiyama University of Chicago Medicine Inflammatory Bowel Disease Center The Transition of the J-Pouch Phenotype in Inflammatory Bowel Disease Patients With Cuffitis IBD ePoster Session Shintaro Akiyama, MD, PhD1, Victoria Rai, BS1, Cindy Traboulsi, MD1, Laura R. Glick, MD1, Yangtian Yi, BA1, Joseph Runde, DO1, Russell D. Cohen, MD2, Roger Hurst, MD1, Neil H. Hyman, MD1, Sushila R. Dalal, MD1, Atsushi Sakuraba, MD, PhD1, Joel Pekow, MD1, Jacob E. Ollech, MD1, David T. Rubin, MD, FACG1; 1University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL; 2University of Chicago Pritzker School of Medicine, Chicago, ILIntroduction: In patients with inflammatory bowel disease (IBD), restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is sometimes required due to medically refractory colitis or neoplasia. However, persistent inflammation in a strip of rectal cuff (cuffitis) and pouchitis frequently develop after the surgery. Our previously reported cross-sectional study identified that cuffitis might be a risk for pouchitis development. This study aimed to understand the transition of the J pouch phenotype in patients with cuffitis.Methods: This is a retrospective single-center study of IBD patients treated by proctocolectomy with IPAA who subsequently underwent pouchoscopies at the University of Chicago between 1997 and 2019. We reviewed all available pouchoscopies to assess the endoscopic findings in different anatomic areas of the pouch: the afferent limb (AL), inlet (IL), “tip of the J”, proximal and distal pouch, anastomosis, and rectal cuff. Endoscopic findings included erythema/edema, erosions/friability, ulcerations, stenosis, granularity, and loss of vascular pattern. Pouchitis was defined as one or more endoscopic findings in any of the tip, proximal, or distal pouch. Diffuse inflammation was defined as two or more endoscopic findings in all anatomical locations of the pouch body. In a Kaplan-Meier (KM) analysis, event-free survival (EFS) was assessed from the scope date when cuffitis was first identified to the date when another phenotype was subsequently developed. We excluded patients if a phenotype was identified simultaneously when cuffitis was initially noted.Results: We reviewed 1,345 pouchoscopies from 422 IBD patients who underwent proctocolectomy with IPAA and identified 192 patients with cuffitis (45%). The rates of AL, IL involvement, diffuse inflammation, and pouchitis were significantly higher in patients with cuffitis compared with those without (Table 1). KM curves demonstrate that the 8-year event-free survival EFS of pouchitis, diffuse inflammation, AL, and IL involvement was 70.4% (95%CI 56.3-80.7), 10.0% (95%CI 0.9-32.3), 37.7% (95%CI 15.9-59.5), and 16.5% (95%CI 15.9-59.5), respectively, with diffuse inflammation having the lowest 8-year event-free survival (Figure 1).Discussion: This study suggests that cuffitis is significantly associated with the subsequent development of some J pouch phenotypes, particularly diffuse inflammation.Table 1. Data of J pouch phenotype in patients with cuffitisFigure 1. Kaplan-Meier curves of the transition of J pouch phenotype in patients with cuffitis.Disclosures:Shintaro Akiyama indicated no relevant financial relationships. Victoria Rai indicated no relevant financial relationships. Cindy Traboulsi indicated no relevant financial relationships. Laura Glick indicated no relevant financial relationships. Yangtian Yi indicated no relevant financial relationships. Joseph Runde indicated no relevant financial relationships. Russell Cohen: AbbVie – Consultant, Grant/Research Support, Speaker's Bureau. Aerpio Therapeutics – Advisory Committee/Board Member. BMS/Celgene – Consultant, Grant/Research Support. Boehringer Ingelheim, Ltd. – Grant/Research Support. Crohn's and Colitis Foundation – Grant/Research Support. Eli Lilly – Consultant. Genentech/Roche – Grant/Research Support. Gilead Sciences – Consultant, Grant/Research Support. Hollister – Grant/Research Support. Janssen Pharmaceuticals – Consultant. Medimmune – Grant/Research Support. Mesoblast Ltd. – Grant/Research Support. NantKwest – Advisory Committee/Board Member. Novus Therapeutics – Advisory Committee/Board Member. Osiris Therpeutics – Grant/Research Support. Pfizer – Consultant, Grant/Research Support. Receptos RedHill Biopharma – Grant/Research Support. Sanofi-Aventis – Grant/Research Support. Schwarz Pharma – Grant/Research Support. Seres Therapeutics – Grant/Research Support. Takeda – Consultant, Grant/Research Support, Speaker's Bureau. UCB Pharma – Consultant, Grant/Research Support.Roger Hurst indicated no relevant financial relationships. Neil Hyman indicated no relevant financial relationships. Sushila Dalal: Abbvie – Speaker's Bureau. Pfizer – Advisory Committee/Board Member.Atsushi Sakuraba indicated no relevant financial relationships. Joel Pekow: AbbVie – Grant/Research Support. CVS Caremark – Consultant. Janssen Pharmaceuticals – Advisory Committee/Board Member. Pfizer – Advisory Committee/Board Member. Takeda – Advisory Committee/Board Member, Grant/Research Support. Verastem – Consultant.Jacob Ollech indicated no relevant financial relationships. David Rubin: AbbVie – Consultant, Grant/Research Support. Abgenomics – Consultant. Allergan, Inc. – Consultant. Biomica – Consultant. Boehringer Ingelheim, Ltd. – Consultant. Bristol-Myers Squibb – Consultant. Celgene Corp/Syneos – Consultant. Check-cap – Consultant. Dizal Pharmaceuticals – Consultant. GalenPharma/Atlantica – Consultant. Genentech/Roche – Consultant, Grant/Research Support. Gilead Sciences – Consultant. GSK (GlaxoSmithKline Group) – Consultant. Ichnos Sciences S.A. – Consultant. InDex Pharmaceuticals – Consultant. Janssen Pharmaceuticals – Consultant, Grant/Research Support. Lilly – Consultant. Narrow River Mgmt – Consultant. Pfizer – Consultant. Prometheus Laboratories – Consultant, Grant/Research Support. Reistone – Consultant. Shire – Consultant, Grant/Research Support. Takeda – Consultant, Grant/Research Support. Techlab, Inc – Consultant.

P1590 (S0785). Herpes Zoster Infection in Patients With Ulcerative Colitis Receiving Tofacitinib: An Update as of May 2019 1387816 Gil Melmed Cedars-Sinai Medical Center Herpes Zoster Infection in Patients With Ulcerative Colitis Receiving Tofacitinib: An Update as of May 2019 IBD ePoster Session Award: Presidential Poster AwardKevin L. Winthrop, MD, MPH1, Gil Y. Melmed, MD, MS2, Séverine Vermeire, MD, PhD3, Nervin Lawendy, PharmD4, Rajiv Mundayat, MSc5, Nicole Kulisek, MD4, Chinyu Su, MD4; 1Oregon Health & Science University, Portland, OR; 2Cedars-Sinai Medical Center, Los Angeles, CA; 3University Hospitals Leuven, Leuven, Vlaams-Brabant, Belgium; 4Pfizer Inc., Collegeville, PA; 5Pfizer Inc., New York, NYIntroduction: Tofacitinib is an oral, small molecule JAK inhibitor for the treatment of UC. In a previous analysis, similar proportions of patients (pts) developed herpes zoster (HZ) with placebo and tofacitinib 10 mg twice daily (BID) during induction, whereas HZ events were higher for tofacitinib 5 or 10 mg BID vs placebo during maintenance [1]. We present an update on HZ in the tofacitinib UC clinical program, as of May 2019.Methods: HZ incidence rates (IRs; unique pts with events per 100 pt-years of exposure) were evaluated in a Phase (P)2 induction study (NCT00787202), 2 P3 induction studies (NCT01465763; NCT01458951), a P3 maintenance study (NCT01458574) and an ongoing, open-label, long-term extension (OLE) study (NCT01470612). Three cohorts were analyzed: Induction (P2 and P3 induction studies), Maintenance (P3 maintenance study) and Overall (all pts receiving tofacitinib 5 or 10 mg BID in P2/P3/OLE studies [data as of May 2019, database not locked]; ≤ 6.8 years of treatment). Cox regression was used for risk factor analysis. No pre-treatment HZ vaccination was required.Results: HZ IRs are shown in the table. Overall Cohort HZ (non-serious and serious) IR was 3.48 (95% CI 2.79, 4.30). Of all HZ, > 90% were mild/moderate in severity, > 90% were resolved at data cut-off and > 90% were non-serious. Eight (9.2%) pts with HZ permanently discontinued. HZ was limited to 1–2 dermatomes in 63 (5.4%) pts, multidermatomal in 17 (1.5%) pts and disseminated in 7 (0.6%) pts (Table); 4 (4.6%) pts had post-herpetic neuralgia. Older age (hazard ratio [95% CI] 1.40 [1.21, 1.63]; p < 0.0001), lower body weight (1.02 [1.01, 1.04]; p < 0.01), North American vs European region (2.14 [1.28, 3.59]; p < 0.05) and prior TNFi failure (1.76 [1.13, 2.74]; p < 0.05) were HZ risk factors. Although not significant in the multivariate model, pts of Asian race had higher HZ risk vs non-Asian pts (univariate model; 1.84 [1.11, 3.06]; p = 0.0187). Baseline steroid use was not a significant risk factor.Discussion: HZ is a known risk with tofacitinib treatment. In the Maintenance Cohort, HZ IR was numerically higher with tofacitinib 10 vs 5 mg BID. Over time in the Overall Cohort, IRs were similar between doses and remained stable vs the previous data cut [1]. Most HZ was non-serious, limited to 1–2 dermatomes. As shown here and in the general population, elderly pts had increased HZ risk. Further study of HZ risk mitigation is warranted for pts with UC receiving tofacitinib.1. Winthrop et al. Gastroenterology 2018;154(S1):1748.Disclosures:Kevin Winthrop: AbbVie – Consultant. Bristol-Myers Squibb – Consultant, Grant/Research Support. Eli Lilly – Consultant. Galapagos – Consultant. Gilead – Consultant. GSK – Consultant. Pfizer Inc – Consultant. Roche – Consultant. UCB – Consultant.Gil Melmed: AbbVie – Consultant. Boehringer Ingelheim – Consultant. Celgene – Consultant. Genentech – Consultant. Janssen – Consultant. Medtronic – Consultant. Pfizer Inc – Consultant. Prometheus Laboratories – Grant/Research Support. Takeda – Consultant. UCB – Consultant.Séverine Vermeire: AbbVie – Consultant, Grant/Research Support, Speaker's Bureau. Abivax – Consultant. Arena Pharmaceuticals – Consultant. Celgene – Consultant. Eli Lilly – Consultant. Ferring – Consultant, Speaker's Bureau. Galapagos – Consultant. Genentech/Roche – Consultant. Gilead – Consultant. GSK – Consultant. Hospira – Consultant, Speaker's Bureau. Janssen – Grant/Research Support, Speaker's Bureau. MSD – Consultant, Grant/Research Support, Speaker's Bureau. Mundipharma – Consultant. Pfizer Inc – Consultant, Grant/Research Support, Speaker's Bureau. Progenity – Consultant. Second Genome – Consultant. Shire – Consultant. Takeda – Consultant, Grant/Research Support, Speaker's Bureau. Tillotts – Speaker's Bureau.Nervin Lawendy: Pfizer Inc – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Rajiv Mundayat: Pfizer Inc – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Nicole Kulisek: Pfizer Inc – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Chinyu Su: Pfizer Inc – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).

P1600 (S0795). Outcomes Combining Vedolizumab With Other Biologics or With Tofacitinib to Treat Inflammatory Bowel Disease 1390360 Ernesto Llano University of Texas Southwestern Medical Center Outcomes Combining Vedolizumab With Other Biologics or With Tofacitinib to Treat Inflammatory Bowel Disease IBD ePoster Session Ernesto M. Llano, MD, Shreeju Shrestha, MSN, Moheb Boktor, MD, David I. Fudman, MD; University of Texas Southwestern Medical Center, Dallas, TXIntroduction: Combining advanced therapies with different mechanisms is a potential strategy to improve outcomes in patients with inflammatory bowel disease who do not achieve a complete response to one drug, however little is known about outcomes of such an approach.Methods: Outcomes of patients who utilized vedolizumab (VDZ) in combination with another advanced therapy (biologic or JAK inhibitor) between 4/1/2016 and 6/1/2020 were examined. VDZ was either added to the first advanced therapy or a second advanced therapy was added to VDZ. Data were retrospectively extracted from electronic medical records at a single tertiary center under an IRB-approved protocol.Results: 14 patients received combination therapy. 10 had ulcerative colitis, 3 Crohn’s disease and 1 indeterminate colitis. All patients were receiving one advanced therapy and had objective evidence of active disease when a second drug was added. Prior to combination therapy, patients failed a median of 2 (range 1-4) other advanced therapies. VDZ was combined with tofacitinib in 9 patients, ustekinumab in 3, and adalimumab in 2. In 50% (7/14) of cases, patients previously received the added drug, with VDZ reutilized in 6 patients and adalimumab in 1. Median time on combination therapy was 31 weeks (IQR 13-47). In patients with elevated C-reactive protein (CRP) or fecal calprotectin (FC) prior to the addition of the second drug and who underwent repeat testing while on combination therapy, normalization of CRP (< 5 mg/L) or FC (< 150 mcg/g) was achieved in 75% (6/8) and 67% (4/6), respectively. Median FC was 326 mcg/g (n = 11) prior to combination therapy and 95 mcg/g (n = 8) on combination therapy. 71% (5/7) of patients on prednisone prior to combination therapy reduced their dose on combination therapy. There were 4 infections; two required hospitalization (rotavirus, C.difficile) and two did not (pneumonia, sinus). 5/14 patients discontinued combination therapy (2 non-response; 1 improvement and de-escalation; 1 non-infectious adverse effect; 1 loss of coverage) prior to the time of this report, while 64% of patients (9/14) remained on combination therapy.Discussion: In this retrospective analysis of a small cohort, combination of VDZ with other biologics or tofacitinib appeared effective in reducing disease activity as measured by inflammatory markers and steroid use and was generally well tolerated.Table 1Table 2Table 3Disclosures:Ernesto Llano indicated no relevant financial relationships. Shreeju Shrestha indicated no relevant financial relationships. Moheb Boktor indicated no relevant financial relationships. David Fudman indicated no relevant financial relationships.

P1620 (S0815). Effect of Mirikizumab on Inflammatory Biomarkers in a Phase 2 Study of Patients With Crohn’s Disease 1390028 Edouard Louis Effect of Mirikizumab on Inflammatory Biomarkers in a Phase 2 Study of Patients With Crohn’s Disease IBD ePoster Session Geert D'Haens, MD, PhD1, Stefan Schreiber2, Edouard Louis3, Bruce E. Sands, MD, MS, FACG4, Elisa Gomez Valderas5, Debra Miller5, Noah Agada5, April N. Naegeli, DrPH, MPH5, Paul Pollack5, Jochen Schmitz5, Janneke Van Der Woude6, Jaroslaw Kierkus7, William J. Sandborn, MD, FACG8; 1Inflammatory Bowel Disease Centre, Academic Medical Centre, Amsterdam, Noord-Holland, Netherlands; 2University Hospital Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany; 3University Hospital CHU of Liège, Liege, Liege, Belgium; 4Icahn School of Medicine at Mount Sinai, New York, NY; 5Eli Lilly and Company, Indianapolis, IN; 6Erasmus University Medical Centre, Rotterdam, Noord-Holland, Netherlands; 7Children’s Memorial Health Institute, Warsaw, Podlaskie, Poland; 8University of California San Diego, La Jolla, CAIntroduction: Mirikizumab (miri; IL-23p19 antibody) is a humanized, IgG4 monoclonal antibody specifically targeting the p19 subunit of the IL23 cytokine. Prior studies have shown miri to have efficacy in psoriasis, ulcerative colitis, and Crohn’s disease (CD). High-sensitivity C-reactive protein (hsCRP) is a known marker of acute inflammation which correlates with disease activity in the majority patients, while fecal calprotectin (FCP) correlates with mucosal inflammation and can be used as a reliable biomarker of mucosal healing [1].Methods: At baseline, subjects (N =191) were randomized with a 2:1:1:2 allocation across 4 treatment arms (PBO, 200, 600, 1000 mg miri, administered intravenously (IV) at Weeks 0, 4, 8). Fecal samples and serum were collected for the assessment of FCP and hsCRP, respectively, at baseline (BL) and Week 12. Comparisons to placebo for continuous data were done using the normal approximation for the Wilcoxon two-sample test. For categorical data, a logistic regression analysis was used with treatment, geographic region, and prior biologic CD therapy (prior biologic experience versus prior biologic naive) as factors.Results: At Week 12, the percent change from BL in hsCRP was significantly greater in all miri groups compared to PBO ([median Q1, Q3] PBO: 43.8 [-8.3, 145.5]; 200mg miri: -29.9 [-64.8, 25.9] pDiscussion: The significant and dose dependent decrease of levels of hsCRP and FCP with miri treatment compared to PBO is consistent with results of clinical and endoscopic parameters and demonstrates the anti-inflammatory activity of miri. Notably, substantial proportions of patients had levels in a range observed in healthy subjects.[1] D'Haens, et al. Inflamm Bowel Dis. 2012; 18: 2218–2224.Disclosures:Geert D''Haens: AbbVie – Advisory Committee/Board Member. Ablynx – Advisory Committee/Board Member. Allergan – Advisory Committee/Board Member. Alphabiomics – Advisory Committee/Board Member. AM Pharma – Advisory Committee/Board Member. Amakem – Advisory Committee/Board Member. Amgen – Advisory Committee/Board Member. Arena Pharmaceuticals – Advisory Committee/Board Member. AstraZeneca – Consultant. Avaxia – Advisory Committee/Board Member. Biogen – Advisory Committee/Board Member. Boehringer Ingelheim – Advisory Committee/Board Member. Bristol-Myers Squibb – Advisory Committee/Board Member. Celgene/Receptos – Advisory Committee/Board Member. Celltrion – Advisory Committee/Board Member. Cosmo – Advisory Committee/Board Member. Dr Falk Pharma – Advisory Committee/Board Member. Echo Pharmaceuticals – Advisory Committee/Board Member. Eli Lilly and Company – Advisory Committee/Board Member. Engene – Advisory Committee/Board Member. Ferring – Advisory Committee/Board Member. Galapagos – Advisory Committee/Board Member. Genentech/Roche – Advisory Committee/Board Member. Gilead – Advisory Committee/Board Member. GlaxoSmithKline – Advisory Committee/Board Member. Gossamerbio – Advisory Committee/Board Member. Hospira/Pfizer – Advisory Committee/Board Member. Immunic – Advisory Committee/Board Member. Johnson and Johnson – Advisory Committee/Board Member. Kintai Therapeutics – Advisory Committee/Board Member. Lycera – Advisory Committee/Board Member. Medimetrics – Advisory Committee/Board Member. Medtronics – Advisory Committee/Board Member. Merck Sharp Dome – Advisory Committee/Board Member. Millenium/Takeda – Advisory Committee/Board Member. Mitsubishi Pharma – Advisory Committee/Board Member. Mundipharma – Advisory Committee/Board Member. Nextbiotics – Advisory Committee/Board Member. Novo Nordisk – Advisory Committee/Board Member. Otsuka – Consultant. Pfizer/Hospira – Advisory Committee/Board Member. Photopill – Advisory Committee/Board Member. Prodigest – Advisory Committee/Board Member. Progenity – Advisory Committee/Board Member. Prometheus Laboratories/Nestle – Advisory Committee/Board Member. Protagonist – Advisory Committee/Board Member. RedHill – Advisory Committee/Board Member. Robarts Clinical Trials – Advisory Committee/Board Member. Salix – Advisory Committee/Board Member. Samsung Bioepis – Advisory Committee/Board Member. Sandoz – Advisory Committee/Board Member. Seres/Nestle – Advisory Committee/Board Member. Setpoint – Advisory Committee/Board Member. Shire – Advisory Committee/Board Member. Teva – Advisory Committee/Board Member. Tigenix – Advisory Committee/Board Member. Tillotts – Advisory Committee/Board Member. Topivert – Advisory Committee/Board Member. Versant – Advisory Committee/Board Member. Vifor – Advisory Committee/Board Member.Stefan Schreiber: AbbVie – Consultant, Speaker's Bureau. Boehringer Ingelheim – Consultant, Speaker's Bureau. Celltrion – Consultant, Speaker's Bureau. Falk Pharma – Consultant, Speaker's Bureau. Ferring – Consultant, Speaker's Bureau. Genentech – Consultant, Speaker's Bureau. Genentech/Roche – Consultant, Speaker's Bureau. Gilead – Consultant, Speaker's Bureau. Janssen – Consultant, Speaker's Bureau. MSD – Consultant, Speaker's Bureau. Novartis – Consultant, Speaker's Bureau. Pfizer – Consultant, Speaker's Bureau. Shire – Consultant, Speaker's Bureau. Takeda – Consultant, Speaker's Bureau.Edouard Louis: Abbvie – Grant/Research Support, Other Financial or Material Support, Personal fees. Celgene – Other Financial or Material Support, Personal fees. European Commission for BIOCYCLE Research Programme – Grant/Research Support. Falk – Other Financial or Material Support, Personal fees. Ferring – Other Financial or Material Support, Personal fees. Janssen – Grant/Research Support, Other Financial or Material Support, Personal fees. MSD – Other Financial or Material Support, Personal fees. Pfizer – Grant/Research Support, Other Financial or Material Support, Personal fees. Takeda – Grant/Research Support, Other Financial or Material Support, Personal fees.Bruce Sands: 4D Pharma – Consultant. Abbvie – Consultant. Allergan Sales – Consultant. Amgen – Consultant. Arena Pharmaceuticals – Consultant. Boehringer Ingelheim – Consultant. Capella Biosciences – Consultant. Celgene – Consultant, Grant/Research Support. Eli Lilly and Company – Consultant. EnGene – Consultant. Ferring – Consultant. Gilead – Consultant. Janssen – Consultant, Grant/Research Support. Lyndra – Consultant. MedImmune – Consultant. Oppilan Pharma – Consultant. Otsuka – Consultant. Palatin Technologies – Consultant. Pfizer – Consultant, Grant/Research Support. Progenity – Consultant. Rheos Medicines – Consultant. Seres Therapeutics – Consultant. Synergy Pharmaceuticals – Consultant. Takeda – Consultant, Grant/Research Support. Target PharmaSolutions – Consultant. Theravance Biopharma R&D – Consultant. TiGenix – Consultant. Vivelix Pharmaceuticals – Consultant. WebMD – Consultant.Elisa Gomez Valderas: Eli Lilly and Company – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Debra Miller: Eli Lilly and Company – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Noah Agada: Eli Lilly and Company – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).April Naegeli: Eli Lilly and Company – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Paul Pollack: Eli Lilly and Company – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Jochen Schmitz: Eli Lilly and Company – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Janneke Van Der Woude: Abbott Laboratories – Advisory Committee/Board Member, Other Financial or Material Support, Financial compensation. FALK Benelux – Advisory Committee/Board Member, Other Financial or Material Support, Financial compensation. Ferring – Advisory Committee/Board Member, Other Financial or Material Support, Financial compensation. Janssen – Advisory Committee/Board Member, Other Financial or Material Support, Financial compensation. MSD – Advisory Committee/Board Member, Other Financial or Material Support, Financial compensation. Mundipharma Pharmaceuticals – Advisory Committee/Board Member, Other Financial or Material Support, Financial compensation. Takeda – Advisory Committee/Board Member, Other Financial or Material Support, Financial compensation.Jaroslaw Kierkus indicated no relevant financial relationships. William Sandborn: Abbvie – Consultant, Grant/Research Support. Allergan – Consultant. Amgen – Consultant, Grant/Research Support. Atlantic Healthcare Limited – Grant/Research Support. Boehringer Ingelheim – Consultant. Celgene – Consultant, Grant/Research Support. Conatus – Consultant. Cosmo – Consultant. Eli Lilly and Company – Consultant, Grant/Research Support. Escalier Biosciences – Consultant, Stockholder/Ownership Interest (excluding diversified mutual funds). Ferring – Consultant. Genentech – Consultant, Grant/Research Support. Gilead – Consultant, Grant/Research Support. Janssen – Consultant, Grant/Research Support. Miraca Life Sciences – Consultant. Nivalis Therapeutics – Consultant. Novartis Nutrition Science Partners – Consultant. Oppilan Pharma – Consultant, Stockholder/Ownership Interest (excluding diversified mutual funds). Otsuka – Consultant. Paul Hastings – Consultant. Pfizer – Consultant. Precision IBD – Consultant, Stockholder/Ownership Interest (excluding diversified mutual funds). Progenity – Consultant, Stockholder/Ownership Interest (excluding diversified mutual funds). Prometheus Laboratories – Consultant. Ritter Pharmaceuticals – Consultant, Stockholder/Ownership Interest (excluding diversified mutual funds). Robarts Clinical Trials – Consultant. Salix – Consultant. Seres Therapeutics – Consultant. Shire – Consultant. Sigmoid Biotechnologies – Consultant. Takeda – Consultant, Grant/Research Support. Tigenix – Consultant. Tillotts Pharma – Consultant. UCB Pharma – Consultant. Vivelix – Consultant.

P1630 (S0825). Prior Surgical History Is the Strongest Risk Factor for Postoperative Crohn’s Disease Recurrence: A Guideline-Based Risk-Stratified Analysis 1390712 Ravi Shah Cleveland Clinic Prior Surgical History Is the Strongest Risk Factor for Postoperative Crohn’s Disease Recurrence: A Guideline-Based Risk-Stratified Analysis IBD ePoster Session Ravi S. Shah, MD1, Takahiro Nakamura, MD2, Salam Bachour, BS3, Stefan Holubar, MD4, Amy L. Lightner, MD4, Florian Rieder, MD4, David P Hudesman, MD5, Benjamin Cohen, MD4, Miguel Regueiro, MD4, Jordan E. Axelrad, MD, MPH6, Benjamin H. Click, MD, MS4; 1Cleveland Clinic, Cleveland, OH; 2New York University Langone Medical Center, New York, NY; 3Cleveland Clinic Lerner College of Medicine, Cleveland, OH; 4Cleveland Clinic Foundation, Cleveland, OH; 5Inflammatory Bowel Disease Center at NYU Langone Health, NYU School of Medicine, New York, NY; 6New York University Grossman School of Medicine, New York, NYIntroduction: Current guidelines recommend preoperative risk stratification to guide postoperative prophylactic biologic therapy for the prevention of Crohn’s disease (CD) recurrence1. Few data have corroborated the quantified risk of postoperative recurrence (POR) and validated the proposed risk stratification. We aimed to assess the impact of biologic therapy on POR based on guideline-recommended risk stratification. Methods: CD patients who underwent an ileocolic resection from 1992-2019 were identified at two tertiary referral centers. Patients were stratified into cohorts with high-risk features (smoking, age < 30 years, and ≥2 prior surgeries) and low-risk features (nonsmokers, age >50 years, resection length < 10 cm, and disease duration < 10 years). POR, defined as endoscopic (Rutgeerts >i1) or radiographic evidence of disease at least >6 months after surgery, was compared between groups. Recurrence-free survival analysis using Cox proportional hazard modeling and Kaplan-Meier curves were used to estimate POR and the impact of biologic prophylaxis. Results: A total of 950 patients with ileocolic resection for CD were included (mean age 37.9, 47%): 785 (82.6%) high-risk and 165 (17.4%) low-risk patients. In the high-risk group, the majority (58.2%) received biologic prophylaxis (43.4% anti-TNF, 7.1% vedolizumab, and 7.8% ustekinumab) while 41.8% had no therapy. In contrast, 60% of low-risk patients had no therapy while 40% received biologic prophylaxis (32.7% anti-TNF, 8% vedolizumab, and 2.4% ustekinumab). In the high-risk group, biologic prophylaxis was significantly associated with earlier POR compared to no therapy (P< 0.001). In the low-risk group, there was no significant difference between biologic and no therapy in time to POR (P=0.10; Figure 1). When assessing specific risk factors on multivariable analysis, ≥2 prior surgeries was the only independent risk factor for POR (P< 0.05). (Table 1) Discussion: The risk stratification proposed for POR in current guidelines may have limited utility in predicting disease recurrence. Low-risk individuals are unlikely to benefit from postoperative biologic prophylaxis. Multiple prior surgeries is the strongest risk factor for POR and these patients may benefit from postoperative biologic prophylaxis. Table 1. Univariate and multivariate Cox Models to Estimate Association Between Components of High-Risk and Low-Risk Groups and Postoperative Recurrence.Figure 1. Recurrence-free survival by risk group and treatment with biologics versus no treatment.*Disclosures:Ravi Shah indicated no relevant financial relationships. Takahiro Nakamura indicated no relevant financial relationships. Salam Bachour indicated no relevant financial relationships. Stefan Holubar indicated no relevant financial relationships. Amy Lightner indicated no relevant financial relationships. Florian Rieder indicated no relevant financial relationships. David P Hudesman indicated no relevant financial relationships. Benjamin Cohen indicated no relevant financial relationships. Miguel Regueiro: Abbvie – Advisory Committee/Board Member, Grant/Research Support. Janssen – Advisory Committee/Board Member, Grant/Research Support. Pfizer – Advisory Committee/Board Member, Grant/Research Support. Takeda – Advisory Committee/Board Member, Grant/Research Support.Jordan Axelrad indicated no relevant financial relationships. Benjamin Click indicated no relevant financial relationships.

P1640 (S0835). Crohn’s Disease Among the Poorest Billion: Survey Data From Low and Lower Middle-Income Countries 1389505 Ruma Rajbhandari Harvard Medical School Crohn’s Disease Among the Poorest Billion: Survey Data From Low and Lower Middle-Income Countries IBD ePoster Session Ruma Rajbhandari, MD, MPH1, Samantha Blakemore, MPH2, Neil Gupta, MD3, Sara Mannan, MPH2, Klejda Nikolli, MPH2, Alison Yih, MPH2, Laura Drown, MPH3, Gene Bukhman, MD, PhD3; 1Harvard Medical School, Cambridge, MA; 2Brigham & Women's Hospital, Boston, MA; 3Harvard Medical School, Boston, MAIntroduction: While Crohn’s Disease has been studied extensively in high-income countries, its epidemiology and care in low and lower-middle income countries (LLMICs) is not well established due to a lack of disease registries and diagnostic capacity. This study aims to understand how IBD and Crohn’s impacts the world’s poorest.Methods: We conducted a cross-sectional survey of gastroenterology providers in countries where the poorest billion live to determine the state of diagnostic and treatment capacity for Crohn’s in LLMICs. Quantitative data was analyzed in R and Excel.Results: Of the 84 providers who expressed interest and were sent the survey link, a total of 46 survey responses from 15 countries were included, giving a response rate of 54.8% (Fig 1). The mean number of patients diagnosed with Crohn’s cared for in the last year was 89.5 overall and varied widely from 0 reported at one facility in Rwanda, to 1,000 reported at two different facilities in India (Table 1). Overall, Crohn’s disease made up 20.6% of the IBD diagnoses reported by survey respondents, with Africa having a larger proportion of Crohn’s compared to ulcerative colitis (UC) than Asia. Most of the providers reported that patients with Crohn’s typically have symptoms for between 6 and 24 months prior to diagnosis and that 26-50% of their patients live in rural areas. The most commonly reported diagnostic challenge is differentiating between Crohn’s and intestinal tuberculosis where it was reported by 70.5% of providers (Fig 2A). Gastroenterologists in Africa struggle with poor Crohn’s disease awareness among providers (47.7%) and lack of trained pathologists (36.4%). First- line Crohn’s medications and IBD surgeries like colectomy and small bowel resection are widely available while the availability of more advanced surgeries and medications is much more variable. The most widely reported challenge in managing Crohn’s disease is patients’ inability to afford biologics, reported by 65% of providers (Fig 2B).Discussion: There appears to be a greater burden of Crohn’s disease in LLMICs than is indicated in the literature. While it appears that most Crohn’s patients are from urban areas as is described in the literature, there does appear to be a signal of Crohn’s in rural areas. Respondents reported many challenges in diagnosing and treating Crohn’s disease, including differentiating it from intestinal TB, poor awareness among providers, and patients’ inability to afford diagnostic testing and treatments like biologics.Figure 1. Number of survey responses from each LLMIC included in the analysis (A); Number of gastroenterologists and endoscopy centers in each country as reported by survey respondents (B)Table 1. Mean and range number of patients diagnosed with IBD and Crohn’s cared for in the last year, and percentage of IBD that is diagnosed as Crohn’s, reported overall, by region, and by country.Figure 2. Challenges faced by providers in diagnosing Crohn’s disease, across all LLMICs (A); Challenges faced by providers in managing Crohn’s disease, across all LLMICs (B)Disclosures:Ruma Rajbhandari indicated no relevant financial relationships. Samantha Blakemore indicated no relevant financial relationships. Neil Gupta indicated no relevant financial relationships. Sara Mannan indicated no relevant financial relationships. Klejda Nikolli indicated no relevant financial relationships. Alison Yih indicated no relevant financial relationships. Laura Drown indicated no relevant financial relationships. Gene Bukhman indicated no relevant financial relationships.

P1650 (S0845). Pharmacokinetics and Immunogenicity of Maintenance Therapy With Ustekinumab: 2-Year Results From the UNIFI Long-Term Extension Study 1388797 Omoniyi Adedokun Janssen Research & Development, LLC Pharmacokinetics and Immunogenicity of Maintenance Therapy With Ustekinumab: 2-Year Results From the UNIFI Long-Term Extension Study IBD ePoster Session Award: Presidential Poster AwardOmoniyi Adedokun, MS, RPh1, Remo Panaccione, MD, FRCPC2, Tadakazu Hisamatsu, MD, PHD3, Maria T. Abreu, MD4, Rupert W. L. Leong, MBBS, FRACP, MD5, David Rowbotham, MD, FRCP, FRACP6, Colleen Marano, PhD1, Yiying Zhou, PhD1, Hongyan Zhang, PhD1, Silvio Danese, MD, PhD7, Waqqas Afif, MD, FRCPC8, Laurent Peyrin-Biroulet, MD9, William J. Sandborn, MD, FACG10, Bruce E. Sands, MD, MS, FACG11; 1Janssen Research & Development, LLC, Spring House, PA; 2University of Calgary, Calgary, AB, Canada; 3Kyorin University, Tokyo, Tokyo, Japan; 4University of Miami Miller School of Medicine, Miami, FL; 5Concord and Macquarie University Hospitals, Sydney, New South Wales, Australia; 6Auckland City Hospital, University of Auckland, Auckland, Auckland, New Zealand; 7Humanitas Research Hospital, Milan, Lombardia, Italy; 8McGill University, Montreal, PQ, Canada; 9Nancy University Hospital, Nancy, Lorraine, France; 10University of California San Diego, La Jolla, CA; 11Icahn School of Medicine at Mount Sinai, New York, NYIntroduction: UNIFI is a phase 3, double-blind, PBO-controlled study that evaluated ustekinumab (UST) treatment in pts with moderate-severe UC who previously failed biologic or conventional therapy. Pts who completed safety and efficacy evaluations at maintenance Wk44 could enter the long-term extension (LTE) continuing the same treatment regimen (PBO or UST 90mg SC q8w or q12w). Starting at Wk56, pts could dose adjust: PBO to UST q8w, UST q12w to q8w, and UST q8w to q8w (sham adjustment).Methods: PK, immunogenicity, and their relationships with efficacy and safety were evaluated among pts who received UST SC in the LTE. Serum UST concentrations (conc) through Wk92 and antibodies to UST (ATU) through Wk96 were determined using validated assays. Clinical efficacy was assessed with symptomatic and partial Mayo remission at Wk92; safety events were evaluated through Wk96.Results: During the LTE, randomized pts who continued 90mg SC UST and did not dose adjust (n=271) had median non-trough UST conc of 6.49−6.66 µg/mL, 4 wks after dosing in the q8w group, and 2.11−2.56 µg/mL, 8 wks after dosing in the q12w group. High proportions (≥80%) of pts were in symptomatic remission and partial Mayo remission at Wk92 in each serum UST conc quartile, thus no clear exposure-response was demonstrable; however, proportions of pts with normalized calprotectin and normalized CRP at Wk92 increased with increasing serum UST conc quartiles (Table). No trends were found between serum UST conc and incidence of infections, serious infection, or serious AEs through Wk96 (Table). Among 400 pts who received continuous UST in induction, maintenance, and the LTE, ATU were found in 22/400 (5.5%) and were often transient. Of these, most (18/22 pts) had titers at or below 1:800; 4 of the 22 pts were positive for neutralizing antibodies. Among pts randomized to UST, the proportions in symptomatic or partial Mayo remission at Wk92 were similar between pts who were positive (80.0%, 80.0%; respectively) and pts who were negative (81.0%, 82.2%; respectively) for ATU. No relationship was observed between ATU and injection site reactions.Discussion: Following treatment with UST 90mg SC q12w or q8w during the LTE, sustained serum UST levels were observed through Wk92 and were generally consistent with serum UST levels observed for these treatment groups during the maintenance study. The incidence of ATU was low and often transient through Wk96, and anti-drug antibodies did not appear to affect efficacy or injection site reactions.Table 1.Disclosures:Omoniyi Adedokun: Janssen Research & Development, LLC – Employee.Remo Panaccione: Janssen Research & Development, LLC – Advisory Committee/Board Member, Consultant, Speaker's Bureau, Other Financial or Material Support, This study was supported by Janssen Research & Development, LLC.Tadakazu Hisamatsu: Janssen Research & Development, LLC – Advisory Committee/Board Member, Consultant, Speaker's Bureau, Other Financial or Material Support, This study was supported by Janssen Research & Development, LLC.Maria Abreu: Janssen Research & Development, LLC – Advisory Committee/Board Member, Consultant, Speaker's Bureau, Other Financial or Material Support, This study was supported by Janssen Research & Development, LLC.Rupert Leong: Janssen Research & Development, LLC – Advisory Committee/Board Member, Consultant, Speaker's Bureau, Other Financial or Material Support, This study was supported by Janssen Research & Development, LLC.David Rowbotham: Janssen Research & Development, LLC – Advisory Committee/Board Member, Consultant, Speaker's Bureau, Other Financial or Material Support, This study was supported by Janssen Research & Development, LLC.Colleen Marano: Janssen Research & Development, LLC – Employee. Johnson & Johnson – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Yiying Zhou: Janssen Research & Development, LLC – Employee.Hongyan Zhang: Janssen Research & Development, LLC – Employee. Johnson & Johnson – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).Silvio Danese: Janssen Research & Development, LLC – Advisory Committee/Board Member, Consultant, Speaker's Bureau, Other Financial or Material Support, This study was supported by Janssen Research & Development, LLC.Waqqas Afif: Janssen Research & Development, LLC – Advisory Committee/Board Member, Consultant, Speaker's Bureau, Other Financial or Material Support, This study was supported by Janssen Research & Development, LLC.Laurent Peyrin-Biroulet: Janssen Research & Development, LLC – Advisory Committee/Board Member, Consultant, Speaker's Bureau, Other Financial or Material Support, This study was supported by Janssen Research & Development, LLC.William Sandborn: Janssen Research & Development, LLC – Advisory Committee/Board Member, Consultant, Speaker's Bureau, Other Financial or Material Support, This study was supported by Janssen Research & Development, LLC.Bruce Sands: Janssen Research & Development, LLC – Advisory Committee/Board Member, Consultant, Speaker's Bureau, Other Financial or Material Support, This study was supported by Janssen Research & Development, LLC.

P1660 (S0855). Efficacy of Ustekinumab in Ileum-Dominant vs Colonic Crohn's Disease 1389663 Sirisha Grandhe University of California Davis Medical Center Efficacy of Ustekinumab in Ileum-Dominant vs Colonic Crohn's Disease IBD ePoster Session Sirisha Grandhe, MD1, Nuen T. Yang, MS2, Sandra L. Taylor, PhD2, Eric J. Mao, MD1; 1University of California Davis Medical Center, Sacramento, CA; 2UC Davis School of Medicine, Sacramento, CAIntroduction: Crohn’s disease (CD) is classified by involvement of the ileum, colon, or both. Ileal CD is associated with increased disease complications and lower response rates to biologic therapies compared with colonic CD. There is limited literature on the efficacy of ustekinumab stratified by CD location. The objective of this study was to determine the real-world efficacy of ustekinumab in patients with ileum-dominant versus colonic CD.Methods: We conducted a single center, IRB-approved, retrospective review of all adult CD patients who received ustekinumab. We stratified patients by ileal involvement: ileum-dominant (ileal and ileocolonic) CD and colonic CD. We collected data on disease behavior, prior biologic therapy, concomitant immunomodulator, CD-related surgeries and hospitalizations, serum c-reactive protein (CRP), and endoscopic presence of ulcers. The primary outcome was absence of ulcers on follow-up colonoscopy. The secondary outcomes included CRP, surgery, and hospitalization. Chi-square tests and two-sample t-tests were used to compare categorical and numeric variables between groups, respectively; analyses were performed using R Computing Software versions 3.6.1.Results: 64 patients with ileum-dominant CD and 22 patients with colonic CD received ustekinumab. Baseline patient characteristics are displayed in Table 1. The median time to follow-up endoscopy was 12 months after ustekinumab initiation. Of 49 patients with follow-up colonoscopy after ustekinumab initiation, 80% (8/10) of colonic CD and 43.6% (17/39) of ileum-dominant CD were ulcer-free (p=0.09). Of 23 patients with endoscopic ulcerations prior to ustekinumab who had a follow-up colonoscopy, 80% (4/5) of colonic CD and 16.7% (3/18) of ileum-dominant CD were ulcer-free (p=0.02). Mean CRP levels trended lower in colonic CD compared with ileum-dominant CD (0.86 +/- 0.87 vs 1.34 +/- 2.19, p=0.34). The rates of hospitalizations and surgeries after starting ustekinumab therapy were similar for both groups.Discussion: This real-world experience on ustekinumab therapy demonstrates a difference in mucosal healing rates between ileum-dominant and colonic CD. Numerically, there is a trend towards lower CRP levels among colonic CD after ustekinumab therapy. This suggests that ileum-dominant and colonic CD may respond differently to ustekinumab therapy. Larger cohorts are needed to further investigate the distinction between ileum-dominant and colonic CD.Table 1. Baseline Characteristics of Patients with Ileum-Dominant and Colonic Crohn's DiseaseDisclosures:Sirisha Grandhe indicated no relevant financial relationships. Nuen Yang: National Center for Advancing Translational Sciences, National Institutes of Health – Grant/Research Support, Grant number UL1 TR001860.Sandra Taylor: National Center for Advancing Translational Sciences, National Institutes of Health – Grant/Research Support, Grant number UL1 TR001860.Eric Mao indicated no relevant financial relationships.

P1670 (S0865). Simultaneous Monitoring of the Inverse Relationship Between Endoscopic Healing Index Scores and Therapeutic Drug Monitoring Across Biologics in Crohn's Disease 1390305 Jennifer Seminerio University of South Florida Simultaneous Monitoring of the Inverse Relationship Between Endoscopic Healing Index Scores and Therapeutic Drug Monitoring Across Biologics in Crohn's Disease IBD ePoster Session Jennifer Seminerio, MD1, Thaeri Cortes, MSc2; 1University of South Florida, Tampa, FL; 2Ponce Health Sciences University, Saint Louis, MOIntroduction: Endoscopic healing index (EHI): MONITR (Prometheus, San Diego, CA) scoring is a proprietary, non-invasive serologic test which compares favorably with the Crohn’s disease (CD) endoscopic scoring system, SES-CD, often considered a gold standard in clinical assessment. The relationship between same day EHI testing performance and therapeutic drug monitoring across multiple biologic agents in the CD patient population is not fully understood. Given the pressing need for non-invasive remote monitoring and optimization of clinical status in the CD patient population, we explored the relationship between simultaneous serum patient clinical monitoring and therapeutic drug monitoring (TDM) as part of standard of care practice.Methods: Adult patients (N=25) were evaluated retrospectively from a cohort of samples seen in an inflammatory bowel disease clinic. The relationship between EHI and TDM concentration was assessed via numeric score for EHI from 0-100 and multiple concentrations of different biologics at a single lab. The analysis was done on multiple biologic agents as part of standard of care practice and the deidentified data compiled.Results: There were 25 CD patients who formed the study population (5 infliximab, 3 adalimumab, 3 vedolizumab and 14 ustekinumab). Across all biologics, increased drug levels were associated with EHI scores < 50. Additionally, within the ustekinumab group (N=14) the average drug levels for the patients with an EHI score >50 and considered to have moderate to severe disease was 1.98ug/mL (n=4) vs 5.17ug/mL (n=7) in patients with a score < 40 and considered to have mild to moderate disease. Discussion: Amongst the biologic treated CD patients, there was evidence of lower drug levels across all biologics in patients with higher EHI scores ( >50). Additional studies are necessary to determine if biologic therapy guided by home EHI will improve longterm clinical trajectories in CD patients and this study will serve as a baseline for prospective analysis of EHI scoring serially and changes in disease status with adjustment of biologics. Disclosures:Jennifer Seminerio indicated no relevant financial relationships. Thaeri Cortes indicated no relevant financial relationships.

P1680 (S0875). Update on Clinical Outcome and Effectiveness of Corticosteroids in Patients With Crohn's Disease in a Population-Based Cohort 1390103 Zeinab Bakhshi Mayo Clinic College of Medicine Update on Clinical Outcome and Effectiveness of Corticosteroids in Patients With Crohn's Disease in a Population-Based Cohort IBD ePoster Session Zeinab Bakhshi, MD1, William Faubion, MD2, William Tremaine, MD1, Edward V. Loftus, Jr., MD, FACG1; 1Mayo Clinic College of Medicine, Rochester, MN; 2Mayo Clinic, Rochester, MNIntroduction: We sought to investigate immediate and long-term outcomes with corticosteroids (CS) in a population-based inception cohort of patients (pts) with Crohn's disease (CD).Methods: We identified all pts who were diagnosed with CD from 1994-2011, followed through 2018, in our county. Outcomes related to first course of CS were assessed by retrospective chart review. Disease severity was determined by the endoscopic and histologic findings. Immediate outcome was categorized as complete symptomatic remission, partial symptomatic response or no response within 1 month of starting CS. Late outcome was categorized as CS-free remission, CS-dependence or non-response within 1 year of CS initiation.Results: This study included 153 CD pts, 53% males, who were diagnosed at median age of 28.2 years and followed for a median of 14.5 years (IQR, 10.3-18.5). Fifty-four pts (36.2%) had mild, 56 (37.6%) had moderate, and 39 (26.2%) had severe CD. Extent was ileal in 26.6%, ileocolonic in 43.5%, colonic in 20.1% and proximal GI in 9.7%. At a median of 28 days after diagnosis, pts required CS for median duration of 3 months (IQR, 2.0-6.5). For the immediate outcome, 88 pts (58.7%) achieved complete remission, 38 (25.3%) were in partial remission, and 24 (16.0%) did not respond to CS. Twenty of the 24 non-responders (83.3%) required bowel resection during follow-up. Eighteen of 20 resections occurred within 1 year of CS initiation (median, 25 days; 13.5-91). Late outcome was assessed at median of 1 year (IQR, 1.0-1.1) after CS. Ninety-one pts (60%) remained CS-free with complete/partial response, 32 pts (21.1%) were CS-dependent, and 29 (19.1%) underwent bowel resection. Pts with moderate/severe CD had significantly higher risk of resection (p=0.0004). One-year cumulative risk of resection was 39.5% (95% CI, 25.3%-55.6%) in severe CD, 16.1% (8.6%-28.1%) in moderate, and 5.8% (1.9%-16.6%) in mild CD. Among 88 pts who required concomitant immunomodulator, 53 (60.2%) started within 1 month of CS start. Among 43 who required biologics, 14 (43%) started within 1 month of CS. Infliximab was most common, followed by adalimumab and certolizumab.Discussion: In this population-based cohort of CD, immediate response to CS occurred in over half despite the fact that over 60% had moderate-severe CD. Over half remained CS-free after 1 year. Rate of intestinal resection (19%) is decreased compared to a previous study (38% in Faubion WA et al, Gastroenterology 2001), perhaps due to concomitant therapies.Disclosures:Zeinab Bakhshi indicated no relevant financial relationships. William Faubion indicated no relevant financial relationships. William Tremaine indicated no relevant financial relationships. Edward Loftus: AbbVie – Advisory Committee/Board Member, Grant/Research Support. Janssen – Advisory Committee/Board Member, Grant/Research Support. Pfizer – Grant/Research Support. Takeda – Advisory Committee/Board Member, Grant/Research Support. UCB – Advisory Committee/Board Member, Grant/Research Support.

P1690 (S0885). Acute Severe Ulcerative Colitis: Is the New Score Proposed by ACG Better to Predict Treatment Outcomes? 1390388 Ana Santos Centro Hospitalar de São João Acute Severe Ulcerative Colitis: Is the New Score Proposed by ACG Better to Predict Treatment Outcomes? IBD ePoster Session Ana L. Santos, MD, Armando Peixoto, MD, Isabel Garrido, MD, Renato Medas, MD, Ana Andrade, MD, Susana Lopes, MD, Guilherme Macedo, PhD; Centro Hospitalar de São João, Porto, Porto, PortugalIntroduction: Recently, the ACG proposed, in its guidelines, a new score to assess the severity of UC; however, this score has not yet been validated, in particular in the subset of patients with acute severe ulcerative colitis(ASUC).Aim: assess the accuracy of the score proposed by the ACG in determining the course of disease and the response to therapy in patients with ASUC, comparing with other scores routinely used.Methods: All consecutive patients admitted to our tertiary referral center due to ASUC, between January2010 and January2020, treated with IVC were enrolled. ASUC was defined according to the adapted Truelove and Witts criteria. Main outcomes evaluated were failure of IVC treatment, need for rescue medical therapy (RMT) and/or colectomy (TC). For all admissions the accuracy of the following severity scores to predict outcomes was calculated and compared between them: Proposed ACG Ulcerative Colitis Activity Index(pACGUCI),MES(Mayo Endoscopic Score),SCCAI(Simple Clinical Colitis Activity Index),Mayo Score(MS),Oxford Score(OS),Lindgren Score(LS) and Edimburg Score(ES).Results: We included 281 admissions(165patients), 54%males, mean age of 40±17years. The IVS failure was 32%, need of RMT 31% and TC 3.6%. Fulminant colitis as classified in the pACGUCI was associated with IVC failure (63.6%vs28.2%, p< 0.001) as well as need for RMT (57.6 vs 27%, p< 0.001). In multivariate analysis, C-reactive protein >10 mg/L in the 3rd day of IVC, [OR=4.019(1.884-8.573), p< 0.001), LS >8points [OR 9.686(1.258-74.557), p=0.029] and MS >10points [OR 7.922(1.091-57.515), p=0.041] were independent predictors of IVC failure. Regarding comparison with other scores, the pACGUCI showed inferiority to predict IVC failure compared to LS and ES [AUC0.619(0.544-0.694),p=0.003 vs AUC 0.671(0.595-0747),p< 0.001 vs AUC 0.622 (0.543-0.700),p=0.002, respectively] but superiority compared to MS [AUC 0.606(0.533-0.680), p=0.007)], MES [AUC 0.590(0.516-0.664),p=0.022], OS [AUC0.573(0.495-0.652), p=0.063], SCCAI [AUC 0.570(0.494-0.646)] and UCEIS [AUC 0.564(0.486-0.642), p=0.040]. Regarding the prediction of RMT, all scores behaved similarly, with an AUC 0.613 (0.537-0.689), p=0.039 for the pACGUCI. In relation to TC, only one score (UCEIS >7 at admission) presented a discriminant ability higher than the other scores [AUC 0.700(0.518-0.881), p=0.033]. Discussion: Despite its ability to identify cases of IVC failure and need of RMT, the pACGUCI does not have a discriminating ability higher than other scores already used.Disclosures:Ana Santos indicated no relevant financial relationships. Armando Peixoto indicated no relevant financial relationships. Isabel Garrido indicated no relevant financial relationships. Renato Medas indicated no relevant financial relationships. Ana Andrade indicated no relevant financial relationships. Susana Lopes indicated no relevant financial relationships. Guilherme Macedo indicated no relevant financial relationships.

P1700 (S0895). Is Two Better Than One? Combination Therapy With Vedolizumab and Tofacitinib for the Treatment of Patients With Inflammatory Bowel Disease 1388835 Andrew Scheinberg University of Miami Miller School of Medicine Is Two Better Than One? Combination Therapy With Vedolizumab and Tofacitinib for the Treatment of Patients With Inflammatory Bowel Disease IBD ePoster Session Andrew R. Scheinberg, MD, Ryan M. Dauer, MD, Oriana M. Damas, MD, Amar Deshpande, MD, Maria T. Abreu, MD, David H. Kerman, MD; University of Miami Miller School of Medicine, Miami, FLIntroduction: Treatment for inflammatory bowel disease (IBD) has changed dramatically over the last 20 years, with many new medications available. Despite advances, only 45% of patients treated with an anti-TNF respond. Recent case studies describe combination therapies targeting more than one therapeutic pathway as a way to improve treatment efficacy. However, the augmented effect of dual therapy on treatment efficacy as well as on increased adverse events remains unclear. Combination therapy of vedolizumab (VDZ), a less immunosuppressant gut-selective biologic, and tofacinitib (tofa), a small molecule cytokine inhibitor with a faster onset of action, is an enticing strategy.Methods: We performed a retrospective cohort study on patients with IBD treated with combination VDZ and tofa at our center in order to evaluate the frequency of clinical response and adverse events. Patient demographics, symptoms, and adverse events documented in the medical record were reviewed and compiled into a database.Results: There were 9 patients with IBD (8 with ulcerative colitis (UC) and 1 with crohn disease (CD). The median age was 48 years (range 20–82) and the median duration of IBD symptoms was 46 months (range 18–129). No patients had concomitant rheumatologic or dermatologic conditions. Seven of the 9 patients were previously treated with anti-TNF therapy, all with lack of response. Four patients were previously treated with VDZ alone and three patients were treated with tofa alone, all with no response. All 9 patients were treated with combination VDZ and tofa (5 or 10mg twice daily) for a median duration of 6 months (0.75–17). Of the 8 UC patients, 62.5% had a clinical response defined as patient-reported improvement in symptoms. Four UC patients were on corticosteroids at baseline and 50% had a reduction in steroid use with combination therapy. Of the 8 UC patients, there were no hospitalizations or reported serious adverse effects including infections. The patient with CD did not respond, was unable to reduce steroid use, and was hospitalized for a flare, ultimately undergoing colectomy for refractory disease.Discussion: Combination therapy with VDZ and tofa resulted in clinical response in 62.5% of UC patients who were previously treatment-refractory to VDZ or tofa alone. Combination therapy did not increase the risk of infection, hospitalization, or other serious side effects. Randomized control studies are needed to better assess the efficacy and safety of this combination in patients with IBD.Disclosures:Andrew Scheinberg indicated no relevant financial relationships. Ryan Dauer indicated no relevant financial relationships. Oriana Damas: Pfizer – Grant/Research Support. PRIME Continuing Medical Education – Other Financial or Material Support, Speaking Roles.Amar Deshpande: American Board of Internal Medicine – Advisory Committee/Board Member. GI Health Foundation – Advisory Committee/Board Member, Consultant. Takeda – Grant/Research Support.Maria Abreu: Boehringer Ingelheim Pharmaceuticals – Consultant. Cornerstone Health, Inc – Consultant. Cosmo Biopharma – Consultant. Eli Lilly – Consultant. Focus Medical Communications – Consultant. Gilead – Consultant. Imedex – Consultant. Janssen – Consultant. Landos Biopharma – Consultant. Pfizer – Grant/Research Support. Prometheus Bioscience – Consultant, Grant/Research Support. Takeda – Consultant, Grant/Research Support. UCB Biopharma SRL – Consultant.David Kerman: Abbvie – Consultant. Academy for Continued Healthcare Learning – Speaker's Bureau. Cleveland Clinic – Consultant. PRIME Continuing Medical Education – Speaker's Bureau.

P1810 (S0924). Is Afferent Limb Length in Post-Pancreaticoduodenectomy Patients a Limiting Factor for Endoscopic Retrograde Cholangiopancreatography? 1388799 Abraham Yu The University of Texas Health Science Center at Houston McGovern Medical School Is Afferent Limb Length in Post-Pancreaticoduodenectomy Patients a Limiting Factor for Endoscopic Retrograde Cholangiopancreatography? Interventional Endoscopy ePoster Session Abraham C. Yu, MD1, Osman Ahmed, MD2, William A. Ross, MD, MBA3, Graciela Nogueras-Gonzalez, MPH3, Brian R. Weston, MD3, Emmanuel Coronel, MD3, Jeffrey H. Lee, MD, MPH3; 1The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX; 2Humber River Hospital, Toronto, ON, Canada; 3University of Texas MD Anderson Cancer Center, Houston, TXIntroduction: Despite the advances in modern endoscopy, endoscopic retrograde cholangiopancreatography (ERCP) remains a challenge in patients who are post-pancreaticoduodenectomy (PD). For post-PD reconstruction, the choledochojejunostomy and pancreaticojejunostomy are frequently placed on a single limb of the jejunum to create the afferent limb. This study evaluated the technical and clinical success rates of ERCP in post-PD patients relative to their afferent limb length (ALL).Methods: We retrospectively evaluated patients with prior classic or pylorus-preserving PD who received ERCP from 01/13/06 - 01/16/19. Operative reports were analyzed for anatomical post-PD reconstruction details. Outcomes included: endoscopic access to the anastomosis of interest, technical success rate - the ability to treat stricture with dilation or stent placement, and clinical success rate - a documented decrease in bilirubin to normal or 50% of peak value within 2 weeks. Statistical analysis was done using Stata/SE version 16.0.Results: A total of 28 patients (75% male; median age 66 years, range 22-86 years) with prior PD (20 classic PD; 8 pylorus-preserving PD) received 66 ERCPs [Table 1]. The median ALL was 42.5 cm (range 40-65 cm) in both surgical groups, 40 cm (range 40-60 cm) in those with pylorus-preserving PD, and 45.0 cm (range 40-65 cm) in those with classic PD. The most commonly used endoscope to reach the anastomosis of interest was a therapeutic upper endoscope (n=31, 47.0%) [Table 2]. For biliary decompression, the choledochojejunostomy was reached on 16/25 initial ERCPs (64%), and on 54/63 (85.7%) total ERCPs when repeat attempts were included. All 3 ERCPs performed for pancreatic intervention were unsuccessful. The technical success rate was 81.0% (51/63 ERCPs) and the clinical success rate was 76.2% (48/63 ERCPs) [Table 3]. In the 9 patients where the enterobiliary anastomosis was not identified, 2 had pylorus-preserving PD, 7 had classic PD, and the median ALL was 40.0 cm (range 40-65). Unsuccessful ERCPs were attributed to sharp bowel angulations (n=5), poor visibility (n=1), and ALL (n=2; length >65cm). There were no perforations or bleeding.Discussion: Overall, ERCP was limited by excessively long afferent limbs (lengths >65cm), but more commonly by sharp bowel angulations that prevented endoscope advancement. Improvements are necessary for the endoscopic management of the pancreaticojejunostomy in patients who are post-PD.All enteric anastomosis were placed on a single limb of the jejunum to create the afferent limbDisclosures:Abraham Yu indicated no relevant financial relationships. Osman Ahmed indicated no relevant financial relationships. William Ross indicated no relevant financial relationships. Graciela Nogueras-Gonzalez indicated no relevant financial relationships. Brian Weston indicated no relevant financial relationships. Emmanuel Coronel indicated no relevant financial relationships. Jeffrey Lee indicated no relevant financial relationships.

P1820 (S0934). Will Endoscopic Suturing Minimize Stricture Formation After Circumferential Resection? Lessons From a Porcine Model 1389943 Carl Manzo Penn State University Milton S. Hershey Medical Center Will Endoscopic Suturing Minimize Stricture Formation After Circumferential Resection? Lessons From a Porcine Model Interventional Endoscopy ePoster Session Abraham Mathew, MD1, Courtney Lester, BS2, Jennifer Izer, DVM, MS3, Carl Manzo, MD3; 1Penn State University Milton S. Hershey Medical Center and College of Medicine, Hershey, PA; 2Penn State University, Hershey, PA; 3Penn State University Milton S. Hershey Medical Center, Hershey, PAIntroduction: Endoscopic submucosal dissection (ESD) plays a role in managing dysplastic Barrett’s esophagus. When a circumferential treatment is needed, endoscopic dissection and resection can lead to formation of a stricture. The primary purpose of this study was to investigate if suturing after circumferential mucosal resection would minimize esophageal scarring and stricture. The secondary aim was to determine the length of the esophageal mucosal segment that could be removed and then successfully approximated.Methods: Female Yorkshire pigs with a goal weight of 66-80lbs were anesthetized for endoscopy under standard veterinary care. Following the procedure, the animals were monitored closely for 3 weeks. The animals were then euthanized and necropsies were performed to assess stricture formation. A total of 12 experiments were planned.In each animal, two circumferential ESD resections of normal esophageal mucosa were performed: one at 34 cm and one at 54 cm in increasing increments starting with 2 cm. In an alternating fashion, one of these two sites was closed via endosuturing with interrupted sutures. The length of tissue to be resected was measured using a calibrated overtube to mark 1 cm increments by thermal coagulation. The length of the resection site was measured following the procedure. A 5-point Likert scale was used to rate the ease of the procedure and ease of tissue approximation for each animal (1 = very easy to 5 = very difficult).Results: Only 3 of the planned 12 animals were studied for a total of six circumferential resections. After resection of a 2 cm ring of tissue, the created gap requiring closure appeared to be a mean of 5 cm. Complete suturing could not be accomplished in any of the animals. The ease of placing sutures was rated as a 1 on the Likert scale. Animal #3, though a larger animal per our request, was euthanized immediately due to inability to place a suture. Future studies under this protocol were discontinued.Discussion: This porcine model demonstrates the challenges of endosuturing in the esophagus after circumferential ESD and offers important lessons. Resection of a short segment circumferentially creates a much wider gap due to retraction of the mucosal edges. The lumen of the porcine esophagus barely accommodates the suturing device and in itself is a limitation. Alternate models are needed for further study.Table 1. Length and difficulty of closure of post-ESD resection site.Disclosures:Abraham Mathew indicated no relevant financial relationships. Courtney Lester indicated no relevant financial relationships. Jennifer Izer indicated no relevant financial relationships. Carl Manzo indicated no relevant financial relationships.

P1830 (S0944). Wet vs Dry Suction Endoscopic Ultrasound Fine Needle Aspiration of Solid Lesions: A Systematic Review and Meta-Analysis 1389760 Daryl Ramai The Brooklyn Hospital Center Wet vs Dry Suction Endoscopic Ultrasound Fine Needle Aspiration of Solid Lesions: A Systematic Review and Meta-Analysis Interventional Endoscopy ePoster Session Daryl Ramai, MD1, Andrew Ofosu, MD2, Jameel Singh, MD3, Mohamed Barakat, MD2, Shahab R. Khan, MBBS4, Saurabh Chandan, MD5, Amaninder Dhaliwal, MD5, Eduardo Quintero, MD6, Derrick Cheung, MD2, Douglas G. Adler, MD7; 1The Brooklyn Hospital Center, Brooklyn, NY; 2Brooklyn Hospital Center, Brooklyn, NY; 3Brooklyn Hospital Center, Port Jefferson, NY; 4Rush University Medical Center, Chicago, IL; 5University of Nebraska Medical Center, Omaha, NE; 6Brooklyn Hospital Center, New York, NY; 7University of Utah School of Medicine, Salt Lake City, UTIntroduction: The optimal sampling techniques for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) remain unclear and have not been standardized. To improve diagnostic accuracy, suction techniques for EUS-FNA have been developed and are widely used among endoscopists. The aim of this study was to compare wet-suction and dry-suction EUS-FNA techniques for sampling solid lesions.Methods: We performed a comprehensive literature search of major databases (from inception to June 2020) to identify prospective studies comparing wet-suction EUS-FNA and dry-suction EUS-FNA. Specimen adequacy, sample contamination, and histologic accuracy were assessed by pooling data using a random-effects model expressed in terms of odds ratio (OR) and 95% confidence interval (CI).Results: Four prospective studies, including a total of 500 patients (257 wet-suction vs 243 dry-suction) were included in our final analysis. The study included a total of 540 lesions (258 pancreatic lesions, 130 hepatic lesions, and 152 other). Pooled rates of sample adequacy for wet-suction EUS-FNA sampling were 91.8% and 76.6% for dry-suction (OR, 3.19; 95% CI, 1.84-5.52; I2=26.1%). Sample contamination rate was 77.0% with wet-suction and 83.3% with dry-suction (OR 0.91; 95% CI 0.61-1.37, I2=15.9%). Histologic accuracy favored patients undergoing wet-suction over dry-suction (84.3% vs 67.5%, OR 8.40; CI 0.29 – 247.0; I2=87%). Very few adverse events were observed and did not impact on patient outcomes using either methods.Discussion: Endoscopic ultrasound fine needle aspiration using the wet-suction technique offers higher specimen quality and histological accuracy with less blood contamination.Forrest plot of studies included in meta-analysisDisclosures:Daryl Ramai indicated no relevant financial relationships. Andrew Ofosu indicated no relevant financial relationships. Jameel Singh indicated no relevant financial relationships. Mohamed Barakat indicated no relevant financial relationships. Shahab Khan indicated no relevant financial relationships. Saurabh Chandan indicated no relevant financial relationships. Amaninder Dhaliwal indicated no relevant financial relationships. Eduardo Quintero indicated no relevant financial relationships. Derrick Cheung indicated no relevant financial relationships. Douglas Adler indicated no relevant financial relationships.

P1840 (S0954). Compliance With ASGE Quality Indicators for Endoscopic Ultrasound Reports in the Evaluation of Pancreatic Cancer: Comparison of Community and Academic Practices 1387868 Michael Weaver Barnes-Jewish Hospital at Washington University in Saint Louis Compliance With ASGE Quality Indicators for Endoscopic Ultrasound Reports in the Evaluation of Pancreatic Cancer: Comparison of Community and Academic Practices Interventional Endoscopy ePoster Session Michael Weaver, MD1, Stephen Hasak, MD, MPH2, Dayna Early, MD1, Daniel Mullady, MD1, Gabriel Lang, MD1, Koushik Das, MD1, Natalie Cosgrove, MD3, William Hawkins, MD1, Ryan Fields, MD2, Marvin Petty, BS, MBA1, Greg Williams, MA, BS3, Rajeev Ramgopal, MD1, Aymen Almuhaidb, MD3, Vladimir Kushnir, MD1; 1Barnes-Jewish Hospital at Washington University in Saint Louis, St. Louis, MO; 2Washington University School of Medicine, St. Louis, MO; 3Washington University, St. Louis, MOIntroduction: The American Society for Gastrointestinal Endoscopy (ASGE) has put forth a list of quality indicators (QI) for EUS which evaluate key steps that provide endoscopists targets to provide high quality care. Endoscopist compliance with the ASGE QI has not been well studied in patients who have undergone EUS and subsequent resection for pancreatic cancer. The goal of this study is to evaluate the quality of EUS performed for pancreatic cancer diagnosis and staging according to ASGE guidelines.Methods: Consecutive patients who had EUS for suspected pancreatic malignancy and who had subsequently undergone surgical resection at a single tertiary care center between 2013 and 2019 were identified by searching an IRB approved surgical database of patients with resected pancreatic cancer. Patients with incomplete documentation were excluded. Patient demographics, pancreatic lesion characteristics, surgical pathology and operative reports, as well as EUS report data were recorded. Analysis of EUS performed at a single academic medical center (AMC) and referring community hospitals (OSH) was performed to compare adherence to ASGE QI.Results: 279 patients underwent surgical resection for pancreatic cancer between 2013-2019 and had an EUS report available for review. 207 EUS were performed at AMC and 72 were performed at OSH. Significant differences between AMC and OSH EUS reports were noted including total number of ASGE QI (6.7±0.1 vs 5.6±0.2, p= < 0.001) included in the report, listing of an ASGE approved indication for EUS (99.5% vs 88.9%, p= < 0.001), documentation of the presence or absence of an intraprocedural complication (100% vs 86.1%, p= < 0.001), use of an on-site cytopathologist (68.9% vs 52.8%, p= 0.015), vascular involvement documentation (78.5% vs 65.3%, p= 0.039), lymph node involvement documentation (89.3% vs 77.8%, p= 0.027), and TNM classification (56.5% vs 19.4%, p= < 0.001) were significantly higher in the AMC EUS reports. EUS-FNA/B revealed malignancy in 88.9% cases at the AMC and 76.4% at OSH (p=0.018).Discussion: In our cohort of patients with resected pancreatic cancer who had previously undergone EUS, the quality of EUS reports from an AMC were superior to OSH EUS reports based on ASGE QI for EUS. Furthermore, there was a statistically significant increase in the diagnostic yield of EUS-FNA/B when comparing EUS from an AMC to EUS from OSH which supports the need of performing high quality EUS for pancreatic cancer and for high quality documentation.Comparison of initial EUS reports between AMC and OSH for all patients with resected pancreatic cancerOverall distribution of the number of quality indicators (QIs) reported on the EUS reportsOverall comparison of key ASGE quality indictors (QIs) in the EUS reportsDisclosures:Michael Weaver indicated no relevant financial relationships. Stephen Hasak indicated no relevant financial relationships. Dayna Early indicated no relevant financial relationships. Daniel Mullady indicated no relevant financial relationships. Gabriel Lang indicated no relevant financial relationships. Koushik Das indicated no relevant financial relationships. Natalie Cosgrove indicated no relevant financial relationships. William Hawkins indicated no relevant financial relationships. Ryan Fields indicated no relevant financial relationships. Marvin Petty indicated no relevant financial relationships. Greg Williams indicated no relevant financial relationships. Rajeev Ramgopal indicated no relevant financial relationships. Aymen Almuhaidb indicated no relevant financial relationships. Vladimir Kushnir indicated no relevant financial relationships.

P1860 (S0974). Post-Procedure Pain and Complications From Endoscopic Ultrasound-Guided Liver Biopsy Compared to Percutaneous Liver Biopsy for Benign Parenchymal Liver Disease 1388983 Thaer Abdelfattah Virginia Commonwealth University and Central Virginia VA Healthcare System Post-Procedure Pain and Complications From Endoscopic Ultrasound-Guided Liver Biopsy Compared to Percutaneous Liver Biopsy for Benign Parenchymal Liver Disease Interventional Endoscopy ePoster Session Thaer S. Abdelfattah, MD, MPH1, Ramzi Hassouneh, DO, MS1, Hamzeh Sarairah, MD2, Puneet Puri, MD3, Pritesh R. Mutha, MD, MPH4, Simran J. Singh, BS4, Michael Fuchs, MD, PhD3, Tilak Shah, MD, MHS3; 1Virginia Commonwealth University and Central Virginia VA Healthcare System, Richmond, VA; 2Virginia Commonwealth University and Central Virginia VA Healthcare System, Lorton, VA; 3Central Virginia VA Healthcare System and Virginia Commonwealth University, Richmond, VA; 4Central Virginia VA Healthcare System, Richmond, VAIntroduction: Endoscopic ultrasound guided liver biopsy (EUS-LB) has emerged as a viable method for core tissue acquisition. Because EUS-LB avoids puncture of the skin and underlying muscle and fascia, we hypothesized the technique would result in less post-procedure pain than percutaneous Liver biopsy (P-LB).Methods: The study was a retrospective review of prospectively maintained EUS-LB and P-LB databases. Exclusion criteria were liver biopsy of a mass lesion, ascites, or coagulopathy (platelets < 50,000 or International Normalized Ratio > 1.5). EUS-LB was performed with a 19-gauge needle using wet suction with heparin or saline. P-LB was performed using a 16-gauge spring-loaded core biopsy needle. Following EUS-LB and P-LB, patients were monitored for 30 and 60 minutes respectively before discharge. Pre- and post-procedure pain location, severity (10-point numeric scale), and use of analgesics was documented in all patients. Patients were contacted within 1 week post-procedure, and the medical records were reviewed for up to 30 days-post procedure to assess for complications. The primary outcome was incidence of increased post-procedural pain. Secondary outcomes were proportion of patients who required analgesics post-procedure, or developed a complication within 30-days post-procedure.Results: 217 patients met inclusion criteria (152 P-LB, 65 EUS-LB). American Society of Anesthesiologists (ASA) classification was higher in the EUS-LB group (3 vs. 2, p < 0.001). Non Alcoholic Fatty liver disease was the most common indication for the procedure in both groups. Other baseline variables did not differ significantly in the 2 groups (Table 1). In the EUS-LB group, 28 patients underwent biopsy of a single lobe, while 37 patients underwent biopsy of both right and left lobes. The incidence of post-procedure pain and need for analgesics was higher with P-LB compared to EUS-LB, but the differences were not statistically significant (Table 2). There was 1 complication in the EUS-LB (abdominal pain requiring admission) and 1 complication in the P-LB group (gallbladder hematoma).Discussion: Both EUS-LB and P-LB with moderate sedation appear to result in acceptably low rates of post-procedure pain and complications. EUS-LB allows for biopsy of left and right liver lobes without significant increase in pain or complications. P-LB with moderate sedation permits safe discharge from the endoscopy unit within an hour post-procedure.Table 1: Baseline variables – EUS-liver biopsy (EUS-LB) vs. percutaneous liver biopsy (PLB) patientsTable 2: Comparison of outcomes between EUS guided liver biopsy (EUS-LB) and percutaneous liver biopsy (PLB) patientsDisclosures:Thaer Abdelfattah indicated no relevant financial relationships. Ramzi Hassouneh indicated no relevant financial relationships. Hamzeh Sarairah indicated no relevant financial relationships. Puneet Puri indicated no relevant financial relationships. Pritesh Mutha indicated no relevant financial relationships. Simran Singh indicated no relevant financial relationships. Michael Fuchs indicated no relevant financial relationships. Tilak Shah indicated no relevant financial relationships.

P1930 (S0990). Impact of Influenza in Patients With Chronic Liver Disease: A National Inpatient Analysis 1389271 Sheena Mago University of Connecticut Health Center Impact of Influenza in Patients With Chronic Liver Disease: A National Inpatient Analysis Liver ePoster Session Sheena Mago, DO1, Marianna Mavilia, DO1, Jinjian Mu, MS1, Jaimy Villavicencio Kim, MD2, Lisa Rossi, MD3; 1University of Connecticut Health Center, Farmington, CT; 2University of Connecticut Health Center, West Hartford, CT; 3Saint Francis Hospital, Hartford, CTIntroduction: Over 4.5 million adults in the US are diagnosed with chronic liver disease (CLD). Acute progression of CLD is associated with immune dysregulation from common infections such as influenza. CDC guidelines recommend yearly influenza vaccination for all patients over the age of 6 months regardless of the presence CLD. Prior small-scale studies demonstrated increased risk of hepatic decompensation and hospitalization amongst cirrhotic patients with influenza, however limited data exists for patients with CLDs besides cirrhosis. This study was conducted to demonstrate the impact of influenza amongst patients with a wider array of CLDs.Methods: A retrospective cohort study was conducted using the 2010-2014 Nationwide Inpatient Sample. Adults hospitalized with influenza were identified using ICD-9 codes (Table 1). The patients were then stratified and compared based on the diagnosis of alcoholic cirrhosis (AC), nonalcoholic cirrhosis (NC), alcoholic fatty liver (AFL), autoimmune hepatitis (AIH), biliary cirrhosis (BC), non-alcoholic fatty liver disease (NAFLD), or no history of CLD.Results: A total of 30,268 adults were admitted with influenza of which 515 (1.7%) patients had CLD and 29,753 (98.3%) did not. Patients with CLD had increased risk of disease severity [OR= 2.66, CI:2.26-3.13, p< 0.001], hospitalization cost [OR=1.24, CI:1.15-1.33, p< 0.001], and length of stay (LOS) [OR=1.07, CI:1.01-1.15, p= 0.031] (Table 2). Despite no overall increased risk in mortality of CLD patients, those with AFL and AC had increased odds of mortality ([OR=39.26, Cl:1.78-428.46, p= 0.003] and [OR= 4.54, Cl:1.23-13.49, p= 0.011], respectively).Discussion: Patients with CLD admitted for influenza had inferior inpatient outcomes, including hospitalization costs, LOS, and disease severity, however there was no statistical difference in mortality. Stratification by CLD demonstrated that increased risk of negative outcomes not only occur in cirrhotic patients, but those with AIH, AFL, and NAFLD. Limitations of this study include the analysis of only hospitalized patients, reliance on ICD coding, and lack of vaccination data. The increased risk of disease severity, hospital charges, and length of stay amongst even a small subset of CLD patients highlights the importance of yearly influenza vaccinations in this population. Prior studies have focused on vaccination against influenza in patients with cirrhosis or post-transplant, however our data demonstrates the importance of vaccination for patients with any CLD.ICD-9 Codes used for Nationwide Inpatient Sample (NIS) data extractionOutcomes for chronic liver disease (CLD) patients admitted with InfluenzaDisclosures:Sheena Mago indicated no relevant financial relationships. Marianna Mavilia indicated no relevant financial relationships. Jinjian Mu indicated no relevant financial relationships. Jaimy Villavicencio Kim indicated no relevant financial relationships. Lisa Rossi indicated no relevant financial relationships.

P1940 (S1000). Is N-Acetylcysteine the Holy Grail in Non-Acetaminophen Related Acute Liver Failure: An Updated Meta-Analysis and Systematic Review 1388236 Saqib Walayat University of Illinois College of Medicine Is N-Acetylcysteine the Holy Grail in Non-Acetaminophen Related Acute Liver Failure: An Updated Meta-Analysis and Systematic Review Liver ePoster Session Saqib Walayat, MD1, Hasan Shoaib, MD1, Muhammad Asghar, MD2, Minchul Kim, PhD1, Sonu Dhillon, MD2; 1University of Illinois College of Medicine, Peoria, IL; 2University of Illinois, Peoria, ILIntroduction: The AASLD recommends N-acetylcysteine (NAC) may be beneficial in non-Acetaminophen related drug induced liver injury. A subsequent review and analysis however reported the current evidence to be inconclusive. Herein, we present an updated review and metanalysis assessing outcomes of NAC in adult patients with acute liver failure.Aims:The primary outcome was to compare the overall survival in adult patients presenting with acute liver failure who received NAC vs those who did not. Secondary outcomes included difference in length of hospital stay, transplant free survival, and posttransplant free survival. Methods: Methods:We included prospective, retrospective, and randomized controlled trials comparing outcomes in patients with acute liver failure (defined as abnormal liver enzymes along with elevated INR >1.5 with or without hepatic encephalopathy) who are ≥ 18 years of age receiving NAC vs control group. Articles were searched in Pubmed, Ovid journals, and Cochrane Database of Systematic Reviews.Results: Three studies (N= 408) that met the inclusion criteria were included in this analysis. Mean age of patients in NAC group was 35.36 years while that in the control group was 37.9 years. Odds of overall survival was significantly higher in NAC group as compared to control group [odds ratio: 3.57, 95% CI: 1.99-6.41]. Transplant free survival was also higher in NAC group as compared to control group [odds ratio: 4.79, 95% CI 3.14-7.31]. Patients in control group had statistically significant odds of longer inpatient stay [MD 2.18; 95% CI: 1.83 to 2.53]. Discussion: In patients with non-Acetaminophen related acute liver failure, NAC significantly improves overall survival and transplant free survival while decreasing overall length of hospital stay.Funnel plot for Overall Survival in NAC groupDisclosures:Saqib Walayat indicated no relevant financial relationships. Hasan Shoaib indicated no relevant financial relationships. Muhammad Asghar indicated no relevant financial relationships. Minchul Kim indicated no relevant financial relationships. Sonu Dhillon indicated no relevant financial relationships.

P1950 (S1010). Can the RETREAT Score Predict HCC Recurrence After Surgical Resection? 1389462 Erinda Stefi Wake Forest Baptist Health Can the RETREAT Score Predict HCC Recurrence After Surgical Resection? Liver ePoster Session Erinda Stefi, DO1, Caleb Melancon, MD1, Timothy Craven, MSPH2, Perry Shen, MD3, Sean Rudnick, MD3; 1Wake Forest Baptist Health, Winston-Salem, NC; 2Wake Forest School of Medicine, Winson-Salem, NC; 3Wake Forest University, School of Medicine, Winston-Salem, NCIntroduction: Recurrent HCC following surgical resection is a major complication. Reliable predictors of HCC recurrence are lacking. Degree of tumor differentiation, the presence of vascular invasion and satellite lesions are often utilized. Alternatively, the risk of recurrent HCC after liver transplantation can be predicted by use of the RETREAT score, which utilizes tumor burden (largest visible tumor + number of visible tumors), presence of microvascular invasion, and plasma α-fetoprotein (AFP) level. We aimed to determine if the RETREAT score can predict the risk of HCC recurrence when applied to patients who have undergone surgical resection for HCC. Methods: Surgical databases at our center were queried to identify 58 patients with cirrhosis who had undergone resection for HCC between 2000-2016. Resection pathology was reviewed to determine the number/size of tumors, and degree of histologic differentiation. Post-resection imaging was reviewed to determine post-operative tumor-free survival by the Kaplan-Meier method. Multivariable proportional hazards regression was used to identify if components the RETREAT score had predictive value for recurrence at pResults: The average age of the cohort was 61  10 yrs; 69% (40/58) were male. The most common etiology of cirrhosis was HCV (55%; 32/58). NAFLD accounted for 12% (7/58). AFP was > 200 ng/mL in 24% (14/58). The 5-year recurrence rate was 65% (38/58). There were no significant differences between the tumor-free group and the HCC recurrence group in gender or racial distribution, liver disease etiology, degree of tumor differentiation, or RETREAT score (all p-values NS). Largest tumor diameter (HR 1.49, 95% CI 1.03 – 2.16 per SD increase of 4 cm) (Fig. 2) and the presence of micro or macrovascular invasion (HR 2.10, 95% CI 1.02 – 4.32) were significant predictors of HCC recurrence risk. AFP was not predictive. Discussion: The RETREAT score did not accurately predict the risk of HCC recurrence in patients undergoing surgical resection. However, contrary to previous studies, these data suggest that the largest tumor size is predictive of recurrence. This is likely because tumor size (in conjunction with number) comprise overall tumor burden, a robust predictor of recurrence. These data confirm the role of vascular invasion in predicting post-resection recurrence. These results are congruent with published data from a large multinational registry.Predicted post-surgical recurrence-free survival for largest tumor diameters of 2.7 cm (25th %-tile) and 8.2 cm (75th %-tile) [p=0.04]Disclosures:Erinda Stefi indicated no relevant financial relationships. Caleb Melancon indicated no relevant financial relationships. Timothy Craven indicated no relevant financial relationships. Perry Shen indicated no relevant financial relationships. Sean Rudnick: Alexion – Speaker's Bureau. Alnylam Pharmaceuticals – Consultant.

P1960 (S1020). Epidemiology of Hepatitis C Virus in Rural Pennsylvania and New York 1389515 Kelley Chan Geisinger Commonwealth School of Medicine Epidemiology of Hepatitis C Virus in Rural Pennsylvania and New York Liver ePoster Session Kelley Chan, BS1, Neeraj Mangla, MD2, Matthew Lincoln, DO2; 1Geisinger Commonwealth School of Medicine, Sayre, PA; 2Guthrie/Robert Packer Hospital, Sayre, PAIntroduction: Hepatitis C virus (HCV) infection is a significant contributor to morbidity and mortality in the United States (US). Current guidelines expanded past screening recommendation from individuals born between 1945-1965 and others at high risk to any asymptomatic person aged 18-79 but do not specify ideal timing for a first time screen. We aim to measure characteristics and pattern of HCV and viral co-infection in an integrated hospital system serving rural northern Pennsylvania and southern New York to provide further clinical guidance for HCV screening.Methods: Retrospective review of the Guthrie network identified 30,549 patients over age 18 with first time HCV screening from January 2014 to December 2019. Prevalence of HCV, genotype, and screening rates for co-infection were calculated. 533 total HCV antibody positive patients were compared to a matched number of randomly selected HCV negative patients. Associations between these cohorts for risk factors and co-infectious screening rates were assessed using chi-squared analysis.Results: The prevalence of positive HCV antibody was 1.7%; 76.8% was genotype 1, 11.6% was genotype 2, 10.4% was genotype 3, and 1.2% was genotype 4. The age of positive HCV antibody patients peaked at 29.13 (95% CI 26.15-31.77) and 59.93 (95% CI 58.71-61.17). Positive HCV antibody was associated with positive urine drug screen (OR 5.9; 95% CI 3.8-9.3), narcotic use (OR 25.4; 95% CI 8.7-77.8), and overdose (OR 17.5; 95% CI 3.0-184.6). HIV, HBV and HAV screening performed in HCV positive and HCV negative patients were 56% and 25%, 45% and 25%, and 32% and 6%, respectively (p< .001). Of those screened for coinfection, prevalence of HIV, HBV immunity and HAV immunity was 0.667% (n=2), 21.6% (n=52), and 25.4% (n=43) in HCV positive patients and 1.5% (n=2), 23.2% (n=31), and 13.3% (n=4) in HCV negative patients.Discussion: We illustrate a bimodal age distribution of positive HCV antibody patients in this rural US population. Patients with a history of positive urine drug screen, narcotic use or overdose had increased odds of HCV infection. Coinfection screening for HIV, HBV and HAV was low overall, but significantly higher in patients with positive HCV antibody. We propose a one time screen for persons aged 35-40 in our region to better eradicate HCV and reduce its associated healthcare burden. This study indicates that provider awareness of co-infection screening is inadequate and that regional demographic analysis may assist specific HCV screening recommendations.Age distribution at time of testing for patients with positive hepatitis C antibodyStratification of hepatitis C virus genotype by percentageForest plot using logarithmic scale of odds ratios for positive hepatitis C antibodyDisclosures:Kelley Chan indicated no relevant financial relationships. Neeraj Mangla indicated no relevant financial relationships. Matthew Lincoln indicated no relevant financial relationships.

P1970 (S1030). The Clinical Impact of Cirrhosis on the Postoperative Outcomes of Patients Undergoing Splenectomy 1389787 David Lee Tufts Medical Center The Clinical Impact of Cirrhosis on the Postoperative Outcomes of Patients Undergoing Splenectomy Liver ePoster Session David U. Lee, MD, Gregory H. Fan, BA, Raffi Karagozian, MD; Tufts Medical Center, Boston, MAIntroduction: Splenectomy may be required in patients with cirrhosis due to severe hypersplenism from portal hypertension or due to non-cirrhosis causes including traumatic injury or laceration of the spleen. In this study, we evaluate the effects of cirrhosis on the postoperative outcomes of patients undergoing splenectomy.Methods: Inpatient splenectomy cases isolated from the 2011-2017 National Inpatient Sample were stratified by the presence of cirrhosis. The cirrhosis and non-cirrhosis cohorts were compared using mortality, length of stay, hospitalization costs, and postoperative complications. A subgroup analysis was performed on the cirrhosis cohort to evaluate the effect of decompensated cirrhosis (presence of hepatic encephalopathy, ascites, variceal bleeding, hepatorenal syndrome, and SBP) on the study endpoints.Results: Of the 28596 splenectomy cases selected from the database, 619 cases (2.16%) included cirrhosis. There was no difference in age (55.8 vs 52.9y p=0.11) between cohorts, but the cirrhosis cohort was more likely to be male (62.7 vs 50.9% p< 0.01). The mortality was higher in the cirrhosis cohort (18.6 vs 5.65% p< 0.01, OR 3.81 95%CI 3.09-4.69), as were the LOS (12.1 vs 10.9d p< 0.01) and hospitalization costs ($214,275 vs $164,792 p< 0.01). The cirrhosis cohort had higher incidences of bleeding complications (7.27 vs 4.65% p< 0.01, OR 1.61 95%CI 1.18-2.19) and sepsis (12.1 vs 8.20% p< 0.01, OR 1.54 95%CI 1.21 -1.97). However, there was no difference between cohorts in the incidences of the bowel perforation (0.49 vs 1.05% p=0.23 OR 0.46 95%CI 0.09-1.36), bowel obstruction (3.55 vs 4.89% p=0.15, OR 0.72 95%CI 0.47-1.10), wound complication (2.26 vs 1.58% p=0.24, OR 1.44 95%CI 0.84-2.47), and postoperative infection (1.94 vs 2.24% p=0.71, OR 0.86 95%CI 0.48-1.53). In a multivariate analysis, cirrhosis was associated with increased hospital mortality (p< 0.01, aOR 2.83 95%CI 2.09-3.78). In a subgroup analysis of cirrhosis patients, the presence of hepatic decompensation was associated with increased hospital mortality (24.4 vs 16.6% p=0.04, OR 1.62 95%CI 1.05-2.51) as well as increased LOS (17.2 vs 10.4d p< 0.01) and hospitalization costs ($308,616 vs $181,390 p< 0.01). Discussion: The presence of cirrhosis is associated with increased hospital mortality in patients undergoing splenectomy. Therefore, these patients require preoperative risk-assessment and multidisciplinary management of both cirrhosis and post-splenectomy complications.Multivariate model: cirrhosis is associated with increased postoperative mortality in patients undergoing splenectomyDisclosures:David Lee indicated no relevant financial relationships. Gregory Fan indicated no relevant financial relationships. Raffi Karagozian indicated no relevant financial relationships.

P1980 (S1040). Risk Factors Associated With Poor Prognosis in Hospitalized Patients With Autoimmune Hepatitis-Induced Liver Failure: A Nationwide Analysis 1389683 David Lee Tufts Medical Center Risk Factors Associated With Poor Prognosis in Hospitalized Patients With Autoimmune Hepatitis-Induced Liver Failure: A Nationwide Analysis Liver ePoster Session David U. Lee, MD, Gregory H. Fan, BA, Raffi Karagozian, MD; Tufts Medical Center, Boston, MAIntroduction: Patients with autoimmune hepatitis (AIH) can develop liver failure during an acute hepatitis flare, which can result in poor patient prognosis and hospital death. It is therefore important to identify the risk factors associated with hospital mortality in these patients in order to stratify the population and provide risk-specific interventions.Methods: Patients with autoimmune hepatitis and liver failure were selected from the 2011-2017 National inpatient Sample and were stratified by mortality into deceased and surviving cohorts. The endpoints included length of stay (LOS), hospitalization costs, hepatic events, and other acute hospital events. Results: Of the 1148 patients with autoimmune hepatitis and liver failure 207 (18%) patients were in the deceased cohort. Compared to the control cohort, the deceased cohort was older in age (57.6 vs 49.5y p< 0.01) but did not have a different gender distribution (female: 75.4 vs 75.1% p=1). Between the deceased and control cohort, the LOS was no different (11.1 vs 9.33d p=0.09), but the average hospitalization cost was higher for the deceased cohort ($206,679 vs $116,334 p< 0.01). The deceased cohort had higher incidences of ascites (39.1 vs 28.5% p< 0.01, OR 1.61 95%CI 1.18-2.21), SBP (10.6 vs 3.40% p< 0.01, OR 3.38 95%CI 1.92-5.95), hepatic encephalopathy (28 vs 15.9% p< 0.01, OR 2.05 95%CI 1.45-2.91), hepatorenal syndrome (24.6 vs 7.23% p< 0.01, OR 4.20 95%CI 2.81-6.27), and portal vein thrombosis (6.76 vs 2.66% p< 0.01, OR 2.66 95%CI 1.36-5.21). However, between the cohorts, there was no difference in the incidence of variceal bleeding (1.45 vs 1.06% p=0.71, OR 1.37 95%CI 0.24-5.38). The deceased cohort had higher incidences of sepsis (60.9 vs 12.1% p< 0.01, OR 11.29 95%CI 8.02-15.9) and acute kidney injury (AKI) (85 vs 31.1% p< 0.01, OR 12.6 95%CI 8.37-18.8), but did not have a different rate of cirrhosis (44.4 vs 40.0% p=0.27, OR 1.20 95%CI 0.89-1.63). in a multivariate model, AKI (p< 0.01, aOR 6.04 95%CI 3.86-9.66) and sepsis (p< 0.01, aOR 6.04 95%CI 4.06-9.04) were found to be associated with in-hospital mortality in patients with liver failure and autoimmune hepatitis.Discussion: In patients with autoimmune hepatitis and liver failure, AKI and sepsis are associated with inpatient mortality. These patients therefore require early risk-assessment, followed by multidisciplinary management of AKI with renal preserving therapies and early recognition/treatment of sepsis with antibiotic therapy.Multivariate model: acute kidney injury and sepsis are independent risk factors of hospital mortality in patients with autoimmune hepatitis-induced liver failureDisclosures:David Lee indicated no relevant financial relationships. Gregory Fan indicated no relevant financial relationships. Raffi Karagozian indicated no relevant financial relationships.

P1990 (S1050). Management of Non-Alcoholic Fatty Liver Disease at Internal Medicine Clinic in South Texas 1390252 Cynthia Rivas University of Texas Rio Grande Valley - Doctors Hospital at Renaissance Management of Non-Alcoholic Fatty Liver Disease at Internal Medicine Clinic in South Texas Liver ePoster Session Cynthia Rivas, MD1, Salman Bangash, MD1, Chelsea Chang, MD2, Michael Machiorlatti, PhD3; 1University of Texas Rio Grande Valley - Doctors Hospital at Renaissance, Edinburg, TX; 2University of Texas Rio Grande Valley, Edinburg, TX; 3University of Texas Rio Grande Valley School of Medicine, Edinburg, TXIntroduction: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of abnormal liver enzymes in primary healthcare in the US. Internal Medicine specialist are the primary physicians diagnosing and managing NAFLD. The use of low-cost, non-invasive tools such as FIB-4 allows for risk stratification aiming early identification of patients with advanced fibrosis in primary care. The aim of our study is to assess patients with NAFLD and their appropriate management and referral to gastroenterology who visited UTRGV Internal Medicine ClinicMethods: A retrospective cohort study was conducted in patients who visited Internal Medicine clinic from January 2017 to December 2019, with a diagnosis of ICD-10 code of fatty liver and/or non-alcoholic steatohepatitis. Laboratory from visit were reviewed along with imaging that supported liver disease. FIB-4 was calculated for all patients. Any patient with history of alcohol abuse, viral hepatitis or a liver genetic condition were excludedResults: A total of 87 patients fulfilled the inclusion criteria. Of those, 58 had imaging modality suggestive of fatty liver. We calculated the FIB-4 in these patients showing that 36% had intermediate-high risk of advanced fibrosis. Overall 20.7% of patients had a gastroenterology/hepatology referral, and of those 61% had public insurance; 22% were uninsured. Logistic regression was used in order to explore the association of these variables with gastroenterology referral; after adjustment this analysis showed that patients with public insurance had an OR 3.76 in comparison to private insurance (95% CI 0.82-17.21, p-value= 0.02) and uninsured patients with OR 4.06(95% CI 1.01-16.25 p-value= 0.02). Patients with intermediate to high risk FIB-4 score had an OR 3.12 (95% CI 0.86-11.34 p-value= 0.08) when compared to those with lower risk Discussion: Our study suggests the majority of patients with higher risk of advanced fibrosis are being referred to Gastroenterology, however those without insurance are limited for a higher level of care. This demonstrates decrease in quality of care in uninsured patients. Given high clinical burden disease, the use of FIB-4 improves risk stratification of patients at no cost, guiding management and appropriate sub-specialist referral for NAFLD patients in the primary care setting. Particularly in South Texas where 30% of population is uninsured. Future analysis will be done with the implementation of a NAFLD algorithm with the use of FIB-4 for risk stratification and management. Table 1. Logistic regression analysis used giving the adjusted Odds Ratio (OR) for 95% Confidence Interval (CI). Models exploring how each covariate individually is associated with NAFLD are reported in table 1.Disclosures:Cynthia Rivas indicated no relevant financial relationships. Salman Bangash indicated no relevant financial relationships. Chelsea Chang indicated no relevant financial relationships. Michael Machiorlatti indicated no relevant financial relationships.

P2000 (S1060). Rates of Vaccine Administration After Liver Transplantation at a Large Tertiary Care Center 1389513 Taha Ashraf Henry Ford Hospital Rates of Vaccine Administration After Liver Transplantation at a Large Tertiary Care Center Liver ePoster Session Award: Presidential Poster AwardTaha Ashraf, MD, Maher Musleh, MD, Vivek Mediratta, MD, Tommy Parraga, MD, George Alangaden, MD, Kimberly Brown, MD, Syed-Mohammed Jafri, MD; Henry Ford Hospital, Detroit, MIIntroduction: There is clear evidence that vaccination prevents morbidity and mortality in high risk populations. We evaluated the quality of vaccination in liver transplant recipients at our institution and to what extent there is adherence to current guidelines.Methods: A retrospective review of patients transplanted between 1/2015-1/2018 at our institution was performed. Data collected included patient demographics, travel distance to transplant center, insurance provider and primary care provider (PCP) visits. Vaccination status and eligibility for Influenza (IV), Pneumococcus (PV), Hepatitis-A (HAV) and B (HBV), Tdap and Td (TdV) were obtained through our EMR and the Michigan Care Improvement Registry. Statistics were calculated using analysis of variance (ANOVA), chi-square, Fisher’s exact test and Wilcoxon Rank Sum Test.Results: 406 patients were evaluated with 336 (83.0%) Caucasians, 44 (10.8%) African-Americans, 15 (3.7%) Hispanics with ages ranging from 21-77 years old. 173 (42.6%) patients received the influenza vaccine in the year prior to transplant whereas only 97 (23.9%) were vaccinated in the year following transplant. 92 (33%) vaccine eligible patients were vaccinated for HAV pre-transplant with 66 (23.7%) patients vaccinated post-transplant, 121 (29.8%) of patients remained unvaccinated. 116 (31.4%) were vaccinated for HBV pre-transplant and 20 (5.4%) post-transplant, leaving 233 (57%) unvaccinated. PV rates increased from 185 (45.6%) to 267 (66%) post-transplant, TdaP 168 (41.4%) to 208 (51.2%) and Td 34 (8.4%) to 40 (10.0%) post-transplant respectively.Post-transplant vaccination was consistently associated with pre-transplant primary care visits (PV: 33.8% vs 57.3% p< 0.001, IV: 54.6% vs 45.6% p=0.121, HAV: 63.6% vs 45.1% p=0.008, HBV 50% vs 47.9%, Tdap: 50.0% vs 36.9% p=0.121). Shorter distance to the transplant center, private insurance, female gender and pre-transplant influenza vaccine administration were also associated with a trend towards higher vaccine rates post-transplant (Table 2).Discussion: Our data reveals vaccination rates in liver transplant recipients decline significantly in the post-transplant period. Additionally, a significant number of at-risk individuals remain unvaccinated. Pre-transplant habits such as regular PCP visits, IV administration and locating close to the transplant center could help improve uptake. As a result of this data, ensuring regular PCP visitation upon transplant listing will be implemented as a quality improvement initiative.Table 1: Demonstrating Vaccination rates pre- and post-liver transplantTable 2: Demonstrating factors influencing vaccine uptake. (F) = Fisher Exact Test, (W) = Wilcoxon Rank Sum Test, (C)= Chi Square Analysis. Distance in MilesDisclosures:Taha Ashraf indicated no relevant financial relationships. Maher Musleh indicated no relevant financial relationships. Vivek Mediratta indicated no relevant financial relationships. Tommy Parraga indicated no relevant financial relationships. George Alangaden indicated no relevant financial relationships. Kimberly Brown indicated no relevant financial relationships. Syed-Mohammed Jafri indicated no relevant financial relationships.

P2010 (S1070). A Phase 3 Study Comparing Switching: Tenofovir Disoproxil Fumarate (TDF) to Tenofovir Alafenamide (TAF) With Continued TDF Treatment in Virologically Suppressed Patients With Chronic Hepatitis B: Final Week 96 Results 1388730 Mandana Khalili A Phase 3 Study Comparing Switching: Tenofovir Disoproxil Fumarate (TDF) to Tenofovir Alafenamide (TAF) With Continued TDF Treatment in Virologically Suppressed Patients With Chronic Hepatitis B: Final Week 96 Results Liver ePoster Session Award: Presidential Poster AwardMandana Khalili, MD1, Pietro Lampertico, MD2, Ho S. Bae, MD3, Xiaoli Ma, MD4, Alnoor Ramji, MD5, Scott Fung, MD6, Sang Hoon Ahn, MD7, Jia-Horng Kao, MD8, Edward Tam, MD9, Patricia Halton, PA-C10, Leland Yee, PhD10, John Flaherty, MD10, Anuj Gaggar, MD10, Yang Liu, MD10, George Wu, PhD10, Hie-Won Hann, MD11, Kosh Agarwal, MD12, Young-Suk Lim, MD, PhD13, Maria Buti, PhD, MD14, Henry Chan, MD15; 1University of California San Francisco, San Francisco, CA; 2Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Lombardia, Italy; 3Asia Pacific Liver Center, Los Angeles, CA; 4Drexel University College of Medicine, Philadelphia, PA; 5University of British Columbia, Vancouver, BC, Canada; 6Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, YT, Canada; 7Saint Vincent Medical Canter, Los Angeles, CA; 8National Taiwan University Hospital, Taipaei City, Taipei, Taiwan; 9Lair Centre, Vancouver, BC, Canada; 10Gilead Sciences, Inc., Foster City, CA; 11Thomas Jefferson University Hospital, Philadelphia, PA; 12Institute of Liver Studies, King’s College Hospital, London, England, United Kingdom; 13Asan Medical Center, University of Ulsan College of Medicine, Seoul, Seoul-t'ukpyolsi, Republic of Korea; 14Hospital General Universitario Valle Hebron and Ciberehd, Barcelona, Madrid, Spain; 15The Chinese University of Hong Kong, Aberdeen, Hong KongIntroduction: We have previously demonstrated at Week 48 that switching to TAF vs continued TDF treatment in CHB patients who were virally suppressed on long-term TDF has shown noninferior efficacy of TAF to TDF with superior bone and renal safety. Here we report the final, efficacy and safety results from this study at Week 96.Methods: In this Phase 3 study (NCT02979613), CHB patients taking TDF for >48 weeks with HBV DNA >12 weeks and Results: Of 488 (TAF 243, TDF 245) patients randomized and treated, 472 (97%; TAF 235, TDF 237) completed 48 weeks of DB treatment, and 465 (95%; TAF 233, TDF 232) completed study treatment through Week 96. At baseline, patient characteristics were similar between groups and have been previously reported. Key efficacy/safety results are summarized in the Table. Virologic suppression (HBV DNA Discussion: In CHB patients on long-term TDF treatment, viral suppression was maintained, ALT normalization increased, and bone and renal safety parameters were improved at Week 96.Disclosures:Mandana Khalili: Gilead science Inc – Grant/Research Support. Gilead sciences Inc – Consultant. Intercept Pharmaceuticals – Grant/Research Support.Pietro Lampertico indicated no relevant financial relationships. Ho Bae: Gilead – Grant/Research Support, Speaker's Bureau.Xiaoli Ma: Gilead Sci In – Speaker's Bureau. Gilead Sci, Inc – Speaker's Bureau.Alnoor Ramji indicated no relevant financial relationships. Scott Fung: Assembly Bio – Advisory Committee/Board Member. Gilead Sciences – Advisory Committee/Board Member, Speaker's Bureau. Springbank Pharma – Advisory Committee/Board Member.Sang Hoon Ahn indicated no relevant financial relationships. Jia-Horng Kao indicated no relevant financial relationships. Edward Tam indicated no relevant financial relationships. Patricia Halton: Gilead Sciences, Inc – Employee.Leland Yee: Gilead Sciences, Inc – Employee.John Flaherty: Gilead Sciences, Inc – Employee.Anuj Gaggar: Gilead Sciences, Inc – Employee.Yang Liu: Gilead Sciences, Inc – Employee.George Wu: Gilead Sciences, Inc – Employee.Hie-Won Hann: Assembly – Grant/Research Support. Gilead – Advisory Committee/Board Member, Grant/Research Support. Trio-Health – Grant/Research Support.Kosh Agarwal indicated no relevant financial relationships. Young-Suk Lim: Gilead – Advisory Committee/Board Member, Consultant, Employee, Grant/Research Support, Patent Holder, Speaker's Bureau, Stockholder/Ownership Interest (excluding diversified mutual funds), Other Financial or Material Support.Maria Buti: gilead – Advisory Committee/Board Member, Grant/Research Support, Speaker's Bureau.Henry Chan: Aligos – Advisory Committee/Board Member. Arbutus – Advisory Committee/Board Member. Gilead Sciences – Advisory Committee/Board Member, Speaker's Bureau. GSK – Advisory Committee/Board Member. Hepion – Advisory Committee/Board Member. Janssen – Advisory Committee/Board Member. Merck – Advisory Committee/Board Member. Mylan – Speaker's Bureau. Roche – Advisory Committee/Board Member, Speaker's Bureau. Vaccitech – Advisory Committee/Board Member. VenatoRx – Advisory Committee/Board Member. Vir Biotechnology – Advisory Committee/Board Member.

P2020 (S1080). Bleeding Events in End Stage Liver Disease Patients Requiring Anticoagulation: A Retrospective Study 1388403 Kayla Estepp University of North Dakota Bleeding Events in End Stage Liver Disease Patients Requiring Anticoagulation: A Retrospective Study Liver ePoster Session Kayla Estepp, DO, Dinesh Bande, MD, Abe Sahmoun, PhD, Dubert Guerrero, MD, Ellen Kronzer, MD; University of North Dakota, Fargo, NDIntroduction: A known complication of end stage liver disease (ESLD), or cirrhosis, is the disruption of the coagulation cascade, resulting in an increased risk for both thrombotic and bleeding events. In theory, this disruption places patients requiring anticoagulants for other hypercoagulable conditions at further risk of bleeding. The overall safety of the different anticoagulant agents in this patient population has not been well studied. The objective of this study is to evaluate occurrence of bleeding events in those patients with diagnosis of ESLD requiring anticoagulants.Methods: A retrospective cohort study in a single academic institution from 2007-2018 utilizingkey words to identify patients with ESLD/cirrhosis with indications for use of anticoagulants. Rates ofbleeding events after initiation of anticoagulants were studied. Subset analyses were conductedon those patients with bleeding events to assess secondary endpoints including site of bleed,secondary risk factors for bleeding events, and which anticoagulant was used, Coumadin orDOAC (apixaban or rivaroxaban).Results: Although those ESLD patients requiring an anticoagulant seemed to experience higherrates of major bleeding events (n=30, 67%) vs minor bleeding events (n=15, 33%), there was nostatistically significant difference in type of anticoagulant used, Coumadin (60%; 53.34%) vsDOAC (40%; 46.67%) with p-value of .2663. No significant difference was noted in site ofbleeds or demographic variables. However there was a notable increase in risk of major bleeding event in thosepatients with concurrent NSAID use, which was statistically significant, (p-value .0319, CI 95%)Discussion: Although a higher percentage of patients with ESLD on an anticoagulant had a majorbleeding event, there was no significant difference in occurrence of major bleeding events that were noted inpatients treated with Coumadin versus DOAC agents. In those patients with ESLD needing ananticoagulant of any kind it needs to be advised to avoid NSAID use given its association withincreased risk of major bleeds in this population. Future studies are needed to better delineate ifthere is a better agent with less risk of major bleeds.Table 1. Baseline Patient Characteristics (** includes DVT, PE, PVT)Table 2. Bleeding Risk FactorsTable 3. Site of Bleed ( * Includes spontaneous rectus sheath hematoma; spontaneous gluteal hematoma)Disclosures:Kayla Estepp indicated no relevant financial relationships. Dinesh Bande indicated no relevant financial relationships. Abe Sahmoun indicated no relevant financial relationships. Dubert Guerrero indicated no relevant financial relationships. Ellen Kronzer indicated no relevant financial relationships.

P2030 (S1090). Correlations Between Biomarkers and Hospital Length of Stay and 30-Day Readmission in Patients With Decompensated Liver Cirrhosis in a Community Health System 1388361 Nazif Chowdhury United Health Services Correlations Between Biomarkers and Hospital Length of Stay and 30-Day Readmission in Patients With Decompensated Liver Cirrhosis in a Community Health System Liver ePoster Session Nazif Chowdhury, MD, Minhaz Ahmad, MD, Maria Bajwa, MD, Leslie Bank, MD, Amine Hila, MD; United Health Services, Johnson City, NYIntroduction: Liver cirrhosis is the 12th leading cause of death in the United States. There are few studies demonstrating the correlations between different biomarkers in patients with liver cirrhosis and 30-day readmission (30DR). Correlations between different biomarkers in patients with liver cirrhosis and hospital length of stay (LOS) are not well-reported.Methods: This study is a retrospective analysis of 958 patients admitted in our health system between 2010 and 2018 with a primary diagnosis of decompensated liver cirrhosis or hepatic encephalopathy. We looked at LOS > 2 days and 30DR for the same diagnosis. Biomarkers included in the study were C-reactive protein (CRP) >0.9 mg/dL, Creatinine (Cr) >1.4 mg/dL, Total Bilirubin (TB) >1.0 mg/dL, Albumin (Alb) < 3.0 g/dL, White blood cell count (WBC) >10,000 K/UL, Hemoglobin (Hb) < 10 g/dL, Platelet (Plt) < 100,000 K/UL, Prothrombin Time (PT) >17 sec, International Normalized Ratio (INR) >1.5 and Ammonia (NH4) >30 Umol/L. Causes of cirrhosis including Alcohol (ETOH), Hepatitis C (HCV) and Non-alcoholic fatty liver disease (NAFLD), and their effect on LOS and 30DR were observed.Results: We found positive correlations between LOS and CRP (r=0.86; p< 0.005), WBC (r=0.73; p< 0.005) and Hb (r=0.90, p< 0.005). No correlations or statistical significance was observed between LOS and Cr, TB, Alb, Plt and NH4. There were positive correlations between LOS and ETOH (r=0.80, p< 0.005) and HCV (r=0.70, p< 0.03); and a negative correlation between LOS and NAFLD (r=-0.38, r< 0.005). We found a positive correlation between 30DR and NH4 (r=0.80, p< 0.005). We found a negative correlation between 30DR and CRP (r=-0.40, p< 0.05), TB (r=-0.32, p< 0.05) and WBC (r=-0.40, p< 0.05). There was no correlation or statistical significance between 30DR and Cr, Alb, Hb, PT, INR, ETOH, HCV and NAFLD.Discussion: Our results indicate that patients who are admitted to the hospital with a diagnosis of decompensated liver cirrhosis or hepatic encephalopathy from ETOH or HCV and also have CRP >0.9 mg/dL, WBC >10,000 K/UL and Hb < 10 g/dL will have a LOS >2 days. We also found that patients with NAFLD have LOS < 2 days. Patients with NH4 > 30 Umol/L on admission will have a high likelihood of being readmitted in 30 days. More studies need to be performed to further extrapolate the correlations between biomarkers and LOS and 30DR in patients with decompensated liver cirrhosis.Disclosures:Nazif Chowdhury indicated no relevant financial relationships. Minhaz Ahmad indicated no relevant financial relationships. Maria Bajwa indicated no relevant financial relationships. Leslie Bank indicated no relevant financial relationships. Amine Hila indicated no relevant financial relationships.

P2050 (S1110). Incidence and Clinical Outcomes of Clostridium difficile Colitis Among Liver Transplantation Recipients From 2007 to 2017 1390656 Aysha Aslam Louis A Weiss Memorial Hospital/UIC Incidence and Clinical Outcomes of Clostridium difficile Colitis Among Liver Transplantation Recipients From 2007 to 2017 Liver ePoster Session Aysha Aslam, MD1, Mohammad Bilal, MD2, Saba Farooq, MD3, Dong Joo Seo, MD4, Shwe Synn, MD5, Surbhi Singh, MD6, Priyanka Chaudhari, MBBS7, Umer Farooq, MD8, Daryl T. Lau, MD, MSc, MPH9; 1Louis A Weiss Memorial Hospital/UIC, Chicago, IL; 2Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; 3University of Connecticut, Middletown, CT; 4Roger Williams Medical Center, Providence, RI; 5Montefiore Medical Center/ Albert Einstein College of Medicine (Wakefield Campus), Bronx, NY; 6The Brooklyn Hospital Center, New York, NY; 7Northside Primary Care Inc., Atlanta, GA; 8Loyola Medicine/MacNeal Hospital, Berwyn, IL; 9Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MAIntroduction: Patients with Liver Transplants (LT) are at high risk for nosocomial infections such as Clostridium difficile (C. diff) colitis. There are limited reports on the epidemiological trends, morbidity and mortality associated with C. Diff infection in the LT patient populations. By examining a large national database in the United States, we identified the epidemiological trends, risk factors and clinical outcomes of C. Diff colitis among the LT recipients in the past decade.Methods: We extracted data from LT patients using International Classification of Diseases (9th/10th Editions) Clinical Modification diagnosis codes (ICD-9-CM/ICD-10-CM) from the National Inpatient Sample (NIS) between 2007 and 2017. C diff and associated clinical information were identified by ICD-9/10-CM codes and validated using Elixhauser comorbidity software. We utilized Cochran Armitage trend test and multivariable survey logistic regression models to analyze the trends, predictors and outcomes using SAS 9.4 version. Results: Among the LT patients in the NIS, there were 12,248 (3.29%) cases of C. diff colitis from 372,814 hospitalizations. The incidence of C.diff increased from 25/1000 in 2008 to 32/1000 in 2017 with a 3% annual increase rate (OR 1.03; 95% CI 1.01-1.05; p=0.001). Patients who developed C.diff were more likely to be males (55%), caucasians (73%), and age 35-50 years (48%). In a multivariable regression analysis, male gender (OR 1.2; 95% CI 1.2-1.3;p< 0.001), septicemia (OR 2.0; 95% CI 1.8-2.2;p< 0.001), renal Failure (OR 1.2; 95% CI 1.1-1.4;p< 0.001), thyroid (OR 1.2; 95% CI 1.1-1.3;p< 0.001) and neurological disorders (OR 1.2; CI 1.01-1.3; p:0.03) were associated with higher risks of C. diff colitis. Although C. diff colitis did not result in an increase in-hospital mortality, it was associated with greater length of stay in the hospital (10d Vs. 6d; p< 0.001) and higher cost burden. C.diff colitis also led to an increase likelihood of discharging to subacute care facility (OR 1.5; 95% CI 1.3-1.7;p< 0.001); this trend increased from 17% in 2008 to 26% in 2017 (P< 0.01)Discussion: In this nationally representative study, we observed the incidence of C.diff colitis among LT recipients has been increasing over the last decade. C.diff colitis is associated with longer hospital stay and considerable morbidity. Early diagnosis and treatment of these susceptible populations is critically important. Further studies are needed to implement preventive strategies to reduce nosocomial C.diff infection.Disclosures:Aysha Aslam indicated no relevant financial relationships. Mohammad Bilal indicated no relevant financial relationships. Saba Farooq indicated no relevant financial relationships. Dong Joo Seo indicated no relevant financial relationships. Shwe Synn indicated no relevant financial relationships. Surbhi Singh indicated no relevant financial relationships. Priyanka Chaudhari indicated no relevant financial relationships. Umer Farooq indicated no relevant financial relationships. Daryl Lau indicated no relevant financial relationships.

P2060 (S1120). Sodium-Glucose Co-Transporter 2 Inhibitors: Promising Results in Transaminase Reduction for the Treatment of Non-Alcoholic Fatty Liver Disease 1389731 Joseph Gabriel East Tennessee State University Sodium-Glucose Co-Transporter 2 Inhibitors: Promising Results in Transaminase Reduction for the Treatment of Non-Alcoholic Fatty Liver Disease Liver ePoster Session Joseph Gabriel, MD1, Laith Al Momani, MD2, Harika Balagoni, MD3, Mohammad Alomari, MD4, Chakradhar Reddy, MD1; 1East Tennessee State University, Johnson City, TN; 2University of Missouri, Kansas City, MO; 3Michigan State University College of Human Medicine, Southfield, MI; 4Cleveland Clinic Florida, Weston, FLIntroduction: Introduction: When non-alcoholic fatty liver disease (NAFLD) is in the race to become the leading indication for liver transplantation, the search for efficacious pharmacological therapies remains crucial. We therefore aimed to systematically review and analyze the literature on the effects of sodium-glucose co-transporter 2 inhibitors on liver enzymes.Methods: Methods: We performed a comprehensive literature search in PubMed, PubMed Central, ScienceDirect, Google Scholar, Embase databases from inception through May 2020 to identify randomized control trials that evaluated the effects of SGLT2 inhibitors in patients with NAFLD on AST, ALT, and GGT. Effect estimates from individual studies were extracted and combined using random effect, generic inverse variance method of DerSimonian and Laird, and a pooled difference in means was calculated. A Forest plot was generated, and publication bias was assessed for using conventional techniques.Results: Results: Five studies with a total of 11,293 patients were included in this analysis. In total, 7,237 patients were placed on an SGLT2 inhibitor with the remaining either continuing standard diabetes treatment without an SGLT2 inhibitor or on placebo. The pooled difference in means of transaminases for SGLT2 inhibitors compared to standard treatment or placebo were as follows: ALT -5.368 (95% CI: -8.960 – -1.777, p 0.003), AST -1.541 (95%CI: -2.355 – -0.728, p 0.000) and GGT -7.501 (95%CI: -13.124 – -1.877, p 0.009).Discussion: Conclusion: NAFLD is currently the most commonly reported chronic liver disease worldwide. However, lifestyle changes remain as the primary treatment with no definitive pharmacological therapy either due to lack of efficacy or possible adverse effects (ie. thiazolidinediones). In our study, there is a statistically significant trend towards improving liver enzymes, albeit small, which may indicate improvement in hepatocellular inflammation. This should lead to further research and large-scale studies that assess the effects of SGLT2 inhibitors on liver fibrosis.Figure 1: Forest plot and pooled difference in means of transaminases in 5 studies for patients on SGLT2 inhibitors vs. placeboDisclosures:Joseph Gabriel indicated no relevant financial relationships. Laith Al Momani indicated no relevant financial relationships. Harika Balagoni indicated no relevant financial relationships. Mohammad Alomari indicated no relevant financial relationships. Chakradhar Reddy indicated no relevant financial relationships.

P2070 (S1130). Measuring Hepatitis C Exposure Prevalence in a Safety Net Hospital in Long Island, New York 1390489 Syed Karim Nassau University Medical Center Measuring Hepatitis C Exposure Prevalence in a Safety Net Hospital in Long Island, New York Liver ePoster Session Syed S. Karim, DO1, Bobby Jacob, MD1, Kevin Yeroushalmi, MD1, Jarin Prasa, MS2, Davinder Singh, MD1, Kristen Farraj, DO1, Charudatta Wankhade, MD1, Pranay Srivastava, MD1, Shino Prasandhan, MD1, Paul Mustacchia, MD1; 1Nassau University Medical Center, East Meadow, NY; 2Touro College of Osteopathic Medicine, East Meadow, NYIntroduction: United States Preventative Service Task Force guidelines recommended one-time HCV Ab screening for patients born between 1945-1965. Some states have implemented mandatory opt-out HCV screening. With new antiviral therapies that have up to 95% success rate, the goal is to direct patients to care and ultimately eradicate HCV. Accurate measurement of the prevalence of HCV, in each district is crucial to implementing strategies at targeted populations. New York is among 9 states that make up about half of the nation's HCV burden. We present the prevalence and demographics of HCV exposed individuals screened in a safety net hospital in Long Island, NY.Methods: Data was analyzed from 1/1/2012 to 8/31/2019 for those that were born between 1945-65. Our EMR system gathered patient charts positive (+) for HCV Ab. Retrospective chart review was performed, reviewing demographics (age, gender, ethnicity), persons with intravenous drug (PWID) use, and HIV co-infected status. Basic statistical analysis was applied.Results: There were a total of 21,722 patients from 1/1/2012 to 8/31/2019 born between 1945-65. Table 1 shows that 1,858 individuals were tested for HCV Ab and 109(5.9%) were found (+). 56(3.0%) patients had active infection demonstrated by detectable RNA. Table 2 shows the demographic characteristics of those (+) for HCV Ab. Within that cohort, 77(70.6%) were male, 32(29.4%) female, 58(53.2%) Caucasian, 37(33.9%) Black, and 6(5.5%) were Asian. There were 17(15.6%) PWID, 4(3.7%) with HIV co-infection, 5(4.6%) individuals who had previous treatment and 2(1.8%) achieved SVR.Discussion: The prevalence of HCV Ab in those born between 1945-65 was estimated to be 5.9% at our institution, which is almost double the national average of 3.2%. Men were more likely to be exposed than women. It is possible that focused efforts, with appropriate allocation of resources, dedicated to HCV case finding and treatment, aimed at safety-net institutions, in states or regions where there is a high burden of HCV, may be an effective strategy for decreasing the population burden of HCV and its sequela.Table 1: HCV Ab Screening for patients born between 1945 - 1965 during January 1, 2012 to August 31, 2019.Table 2: Demographic data of patients screened and found to have HCV Ab.Disclosures:Syed Karim indicated no relevant financial relationships. Bobby Jacob indicated no relevant financial relationships. Kevin Yeroushalmi indicated no relevant financial relationships. Jarin Prasa indicated no relevant financial relationships. Davinder Singh indicated no relevant financial relationships. Kristen Farraj indicated no relevant financial relationships. Charudatta Wankhade indicated no relevant financial relationships. Pranay Srivastava indicated no relevant financial relationships. Shino Prasandhan indicated no relevant financial relationships. Paul Mustacchia indicated no relevant financial relationships.

P2080 (S1140). Efficacy of Internal Medicine Clinic HCV Screening and Referral to GI Clinic for Treatment 1390528 Tess Petersen Lankenau Medical Center Efficacy of Internal Medicine Clinic HCV Screening and Referral to GI Clinic for Treatment Liver ePoster Session Tess L. Petersen, MD, Jared Lander, DO, Elizabeth Richardson, DO, Megan Buckley, DO, Catherine Kuntz, MD, Gary Newman, MD; Lankenau Medical Center, Wynnewood, PAIntroduction: With advances in Hepatitis C Virus (HCV) infection treatment resulting cures in more than 95% of patients, primary care practices should be screening all patients born between 1945 and 1965 as indicated by the Centers for Disease Control and U.S. Preventive Services Task Force recommendations. The aim of this study is to determine whether increasing HCV screening in our primary care clinic increased referral to GI clinic and treatment for HCV.Methods: In our internal medicine residency clinic with an 80% inner-city population, HCV infographic campaign posters were hung throughout working areas to serve as both a visual reminder to screen patients and an education resource on who should be screened. A retrospective chart review was performed of visits from the 2016 calendar year (pre-intervention) and the 2017 calendar year (post intervention) for all patients born between 1945 and 1965. Screening rates were compared pre and post-intervention. From these data it was previously determined that hanging readily available CDC posters on HCV screening increased screening rates between 2016 and 2017. The present study expands on these data to determine whether increasing HCV screening increased referral to GI clinic and treatment for HCV. Of those who screened positive, data including time to referral to GI clinic, treatment regimen, and treatment outcome was collected to evaluate the efficacy of internal medicine clinic HCV screening and referral to GI clinic for treatment.Results: In this quality improvement study within our resident clinic, we found that hanging CDC posters on HCV screening increased screening rates from 27% to 38% between 2016 and 2017 respectively (P=0.006). 5 patients screened positive in 2016. Of these, 4 (80%) were referred to GI clinic and the fifth patient had negative PCR and thus did not require referral. One patient who screened positive followed up at a different center for treatment. 2 patients screened positive in 2017. Of these, 2 (100%) were referred to GI clinic. 3/7 were treated with glecaprevir/pibrentasvir and 2/7 were treated with elbasvir/grazoprevir. 5/7 who screened positive between 2016-2017 achieved sustained virologic response 24 weeks after completion of therapy.Discussion: Our study demonstrates that internal medicine residency clinics can increase Hepatitis C screening numbers by an easy, inexpensive method. Further, we demonstrate that by increasing screening we have increased the number of patients referred to GI and cured of HCV. Disclosures:Tess Petersen indicated no relevant financial relationships. Jared Lander indicated no relevant financial relationships. Elizabeth Richardson indicated no relevant financial relationships. Megan Buckley indicated no relevant financial relationships. Catherine Kuntz indicated no relevant financial relationships. Gary Newman indicated no relevant financial relationships.

P2090 (S1150). Predictors of Development of Hepato-Renal Syndrome in Cirrhotic Patients With Acute Kidney Injuries 1389808 Roula Sasso Staten Island University Hospital Predictors of Development of Hepato-Renal Syndrome in Cirrhotic Patients With Acute Kidney Injuries Liver ePoster Session Roula Sasso, MD1, Liliane Deeb, MD2; 1Staten Island University Hospital, New York, NY; 2Staten Island University Hospital, Staten Island, NYIntroduction: Acute kidney injury (AKI) is a serious complication of liver cirrhosis with high mortality rates. Hepato-renal syndrome (HRS) is the cause of AKI in approximately 10-20% of cirrhotic patients while prerenal AKI and acute tubular necrosis are more common causes. Correct differentiation is imperative as management and outcomes differ substantially. Diagnosis of HRS is often delayed requiring 48 hours of attempts at volume expansion before a definitive diagnosis can be made. Mortality associated with HRS is substantially higher compared to other causes of AKI and treatment requires a timely multidisciplinary approach. We hypothesize that the risk of HRS can be predicted based on patient’s baseline clinical characteristics and laboratory values at the time of development of AKI. We aim to describe potential variables associated with HRS in cirrhotic patients presenting with AKI.Methods: This is a retrospective analysis of 235 cirrhotic patients admitted with AKI to Staten Island University Hospital, NY. We collected demographics, medical history, vital signs, laboratory data, medications, procedures during hospital stay and outcomes. Patients with a diagnosis of HRS were identified as a separate group. We performed a bivariate analysis to determine variables associated with the development of HRS.Results: Patients were predominantly males (61%) and Caucasians (55%). Mean age of our cohort was 66 (±13) years. Alcoholic liver cirrhosis was the most common etiology (52%). The mean Charleson Comorbidity Index (CCI) score and MELD score were 5 and 18, respectively. Ascites was the most encountered clinical sign of portal hypertension (21%). 16% of patients received albumin and 25 patients (11%) were diagnosed with HRS. Death occurred in 11% of patients. Variables that were statistically significantly associated with the diagnosis of HRS included alcoholic cirrhosis, higher CCI and MELD scores, clinical signs of portal hypertension (history of hepatic encephalopathy and/or ascites), lower platelet count and sodium level, higher bilirubin and INR. Mortality in patients with HRS was 40%.Discussion: HRS-AKI is a diagnosis of exclusion and is often difficult to establish. We identified clinical variables and laboratory data that can guide clinicians through an early diagnosis of HRS to allow for a better targeted approach in an attempt to lower mortality. We intend on developing a predictive model for the diagnosis of HRS based on the identified associated variables identified in this study.Table 1: Clinical characteristics and outcomes of cirrhotic patients admitted with Acute Kidney injuryTable 2: Variables associated with the development of HRS in cirrhotic patients admitted with Acute Kidney Injury.Disclosures:Roula Sasso indicated no relevant financial relationships. Liliane Deeb indicated no relevant financial relationships.

P2100 (S1160). Obeticholic Acid Increases Hepatic Artery Flow Rate in Non-Cirrhotic Porcine Livers Perfused Using a Cardio-emulation Pump System: Possible Mechanism of Action in NASH 1388320 Gerond Lake-Bakaar Transplant Institute, Porter Adventist Hospital Obeticholic Acid Increases Hepatic Artery Flow Rate in Non-Cirrhotic Porcine Livers Perfused Using a Cardio-emulation Pump System: Possible Mechanism of Action in NASH Liver ePoster Session Gerond V. Lake-Bakaar, MD, PhD1, John Robertson, VMD, PhD2, Charles Aardema, BS3; 1Transplant Institute, Porter Adventist Hospital, Denver, CO; 2Virginia Tech Carilion School of Medicine, Blacksburg, VA; 3Biomedinnovations LLC, Denver, NCIntroduction: Obeticholic acid (OCA) has demonstrated significant beneficial effects in the treatment of non-alcoholic steatohepatitis, NASH. However, the associated mechanisms are not fully elucidated. Accumulating evidence continues to link hypoxia-regulated mechanisms and pathways with the pathogenesis of obesity and NASH. Specifically, oxygen therapy alleviates NASH.The hepatic artery HA delivers 50 percent of the oxygen requirements to the liver. OCA modulates intrahepatic vasodilator responses. Significant increase in HA blood flow associated with OCA treatment, offers alternative mechanisms of action for this drug in NASH. Using porcine livers, perfused ex vivo under constant pressure conditions with a cardio-emulation pump CaVESWave®, we studied the effect of progressively increasing doses of OCA on flow rates in the hepatic artery HA, portal vein PV and hepatic vein HV.Methods: Following procurement and flushing, six livers (two controls) were placed in ice water baths, transported to the laboratory and connected to the CaVESWave® system. Total cold ischemic time was approximately 120 mins. Perfusion was initiated with the HA settings at 120/80 mmHg, PV below 15 mmHg and temperature at 15° C. Sensing data collected during perfusion, including pH, DO (dissolved oxygen), conductivity, temperature, pressure and flow rates on all vascular channels (hepatic artery, portal vein, hepatic vein) were collected. The treatment protocol commenced after the hepatic venous outflow stabilized beginning with an initial dose of 0.14 mg OCA/kg weight of liver and followed by increasing doses of 0.28, 0.56 and 1.12 mg/kg, added at 30 min intervals.Results: The control livers (n=2) showed minor changes in flow after treatment with vehicle. The maximum increase in flow was 3.3 + 3.5% for the HA and 4.8 + 2.8% for the HV. By contrast, PV flow was reduced by up to -9.1 + 5.9%. In the drug treated livers (n=4), there was a clear dose relationship between OCA and HA, HV and PV flow rates. Hepatic venous outflow increased progressively to 11 + 11.8% and HA to 9.9 + 8.9%. Conversely, PV flow was reduced by -19 + 16% (fig. 2).Discussion: In this non-cirrhotic porcine liver model, OCA in dose responsive manner increased flow rates in the HA, a major source of oxygenated blood to the liver. Increased hepatic oxygenation offers a possible mechanism of action of OCA in NASH. The concomitant reduction of PV flow could provide significant secondary benefits in the treatment of portal hypertension in cirrhotic livers.Disclosures:Gerond Lake-Bakaar indicated no relevant financial relationships. John Robertson indicated no relevant financial relationships. Charles Aardema indicated no relevant financial relationships.

P2110 (S1170). Observations of Patients With Cirrhosis Admitted With an Upper GI Bleed and Areas for Improvement 1389665 Andrew Scheinberg University of Miami Miller School of Medicine Observations of Patients With Cirrhosis Admitted With an Upper GI Bleed and Areas for Improvement Liver ePoster Session Andrew R. Scheinberg, MD1, Angeli Patel, MD2, Joao Serigado Soares Da Costa, MD1, Rikera Taylor, BS1, Patricia D. Jones, MD, MSCR1; 1University of Miami Miller School of Medicine, Miami, FL; 2University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FLIntroduction: Cirrhosis, a major cause of morbidity and mortality in the United States, is annually responsible for more than 200,000 admissions and billions of dollars to the healthcare system. Upper GI Bleed (UGIB), a potentially fatal complication of cirrhosis, is associated with significant readmission rates and high mortality. In this study, we describe the utilization of various quality metrics in a sample of patients with cirrhosis admitted with an UGIB.Methods: We performed a retrospective chart review of patients admitted with cirrhosis and UGIB to two academic hospitals, University of Miami Hospital and Jackson Memorial Hospital, between 10/1/2017 to 10/1/2018. Patients were excluded if they did not have cirrhosis or qualifying admissions (Figure 1). We performed univariate analysis to describe patient demographics and specific patient-care practices pertaining to UGIB.Results: Overall, there were 52 total eligible admissions admitted with a primary diagnosis of UGIB. In 24 patients, the index admission was for UGIB. Of these 24 patients, their underlying liver disease etiology included 54% with Alcohol-related Liver Disease, 20.8% Non-alcoholic liver disease, and 20.8% with Hepatitis C. One patient died during their index admission, 4.2%, and two were discharged to hospice, 8.4%. Of all those with bleeding during their index admission, 83% had an upper endoscopy (EGD); 4 patients did not receive an EGD for non-specified reasons. Only 2 patients were discharged with an outpatient EGD scheduled. Twelve patients with an index admission for UGIB were readmitted. In 50%, the subsequent admission was due to UGIB.Of all 52 eligible UGIB admissions, 45 had an EGD and 82.2% were found to have esophageal varices (EV); in 59.4% cases this was felt to be the etiology of the UGIB. Of 37 with EVs, only 40.3% patients were discharged on a beta-blocker. Of all UGIB admissions, 77% were started on antibiotics and 13.4% were scheduled for follow up EGD as an outpatient.Discussion: Most patients admitted with UGIB receive an EGD during their admission; however, there remain opportunities for improvement in the quality of care. Mainly, increased use of antibiotics on admission, beta-blocker prescription for those with EVs, and scheduled outpatient follow-up EGD upon discharge may help reduce readmissions due to recurrent bleeding. Implementation of electronic medical record-based order sets may help standardize these practices and improve these various quality metrics.Figure 1. Flow Chart of Patients Included in AnalysisTable 1. Demographics of Patients With an Upper Gastrointestinal Bleed (UGIB) on Index AdmissionTable 2. Quality Metric Questions for Patients Admitted with an UGIBDisclosures:Andrew Scheinberg indicated no relevant financial relationships. Angeli Patel indicated no relevant financial relationships. Joao Serigado Soares Da Costa indicated no relevant financial relationships. Rikera Taylor indicated no relevant financial relationships. Patricia Jones indicated no relevant financial relationships.

P2120 (S1180). Low Impact of Co-Morbid Conditions on the Diagnosis of Covert Hepatic Encephalopathy in a Cohort of 690 Patients With Cirrhosis 1389718 Omar Nadhem Virginia Commonwealth University Health System Low Impact of Co-Morbid Conditions on the Diagnosis of Covert Hepatic Encephalopathy in a Cohort of 690 Patients With Cirrhosis Liver ePoster Session Omar Nadhem, MBChB1, Chathur Acharya, MBBS1, Jawaid Shaw, MBBS1, Ramzi Hassouneh, DO, MS2, Andrew Fagan, BS3, Sara Mcgeorge, MS4, Richard Sterling, MD, MSc, FACG4, James Wade, PhD4, Leroy R. Thacker, PhD4, Jasmohan Bajaj, MD, FACG1; 1Virginia Commonwealth University Health System, Richmond, VA; 2Virginia Commonwealth University and Central Virginia VA Healthcare System, Richmond, VA; 3Hunter Holmes McGuire VA Medical Center, Richmond, VA; 4Virginia Commonwealth University, Richmond, VAIntroduction: Covert hepatic encephalopathy (CHE) is epidemic in cirrhosis and can predict hospitalizations, overt HE (OHE) and death. Diagnosis is based on specialized testing including paper-pencil methods. These tests are sensitive but could be impacted by co-morbid condition & medications that are often seen in cirrhotic patients Data on the influence of other non-cognitive covariates is limited. We aimed to examine the non-cognitive variables that could influence CHE testing using psychometric hepatic encephalopathy score (PHES) and components.Methods: Patients with cirrhosis >18 years were enrolled from clinics between 2008-2019 & underwent CHE testing. Those with uncontrolled psychiatric comorbidities and those actively abusing alcohol/drugs were excluded. CHE was diagnosed based on published norms. T tests/Wilcoxon test and logistic regression were done. Dependent variable was CHE on PPT. A multivariable model was constructed, then OHE was added to see if the variables were significant. Backward elimination process was applied to determine significant interactions between OHE and other variablesResults: We included 690 patients With median (IQR) age of60 (56,64) years, Education 13(12,14) years, MELD 11(8,16), Childs score 6(5,8). The majority were men (84%) with HCV (48%) followed by alcohol (17%) and NAFLD (12%). Prior OHE was present in 35.5% (on lactulose 9%, rifaximin also 27%), Ascites 43.7% (refractory in 12.5%), past variceal bleeding, 14.5% and HCC in 15.5%. Hypertension was present in 54.6%, CAD 9%, CHF 2.4%, COPD 6.2%, Depression 28.9%, Anxiety 6.6% & PTSD 6.8%. 21% were using opioids & 40% were on PPIs. Lactulose only was used by 9% and Rifaximin by 26.5%. CHE was diagnosed in 59%. On univariable analysis age, male sex, education, alcoholic and NASH etiologies, MELD score, Child score, prior OHE, ascites, refractory ascites, HCC, lactulose, rifaximin, opioid & PPI use were significant. On multivariable analysis higher age, being male with alcohol-related etiology, prior OHE, with higher Child score & opioid use and lower education independently predicted CHE. None of the other medications or co-morbid conditions were contributory.Discussion: In this large cohort of cirrhotic patients, only liver disease severity, opioid use &demographics, but not other co-morbid conditions, impact CHE results. Paper-pencil testing should be adjusted or controlled for these factors but otherwise CHE testing reflects liver-specific changes on brain function.Disclosures:Omar Nadhem indicated no relevant financial relationships. Chathur Acharya indicated no relevant financial relationships. Jawaid Shaw indicated no relevant financial relationships. Ramzi Hassouneh indicated no relevant financial relationships. Andrew Fagan indicated no relevant financial relationships. Sara Mcgeorge indicated no relevant financial relationships. Richard Sterling indicated no relevant financial relationships. James Wade indicated no relevant financial relationships. Leroy Thacker indicated no relevant financial relationships. Jasmohan Bajaj indicated no relevant financial relationships.

P2500 (S1190). Identifying Patients With Type 2 Diabetes Mellitus Who Require Pharmacotherapy for Nonalcoholic Steatohepatitis (NASH) Using the FAST Score 1387860 Pankaj Aggarwal University of Texas Health Science Center Identifying Patients With Type 2 Diabetes Mellitus Who Require Pharmacotherapy for Nonalcoholic Steatohepatitis (NASH) Using the FAST Score Obesity ePoster Session Award: Presidential Poster AwardPankaj Aggarwal, MD1, Tamneet Singh, MD1, Allison Harrington, MD1, Oladuni Cummings-John, MD2, Anita Kohli, MD3, Mazen Noureddin, MD4, Naim Alkhouri, MD1; 1University of Texas Health Science Center, San Antonio, TX; 2Texas Liver Institute, San Antonio, TX; 3Arizona Liver Health, Chandler, AZ; 4Cedars-Sinai Medical Center, Los Angeles, CAIntroduction: Patients with type 2 diabetes (T2DM) have a high prevalence of fatty liver and are at higher risk for NASH and fibrosis. New pharmacologic agents to treat fatty liver in patients with T2DM are expected to be approved in 2020 and will target those with NASH and significant fibrosis (NASH-F). The FAST (Fibroscan + AST) score was recently developed to predict the presence of NASH-F based on measuring controlled attenuation parameter (CAP) for steatosis, liver stiffness measurement (LSM) for fibrosis, and AST for inflammation. The aim of this study was to assess the utility of FAST score in patients with T2DM to identify those that require NASH pharmacotherapy. Methods: Consecutive patients with T2DM who presented for evaluation of fatty liver were included. All had Fibroscan to measure CAP and LSM + AST within 6 months. Based on published data, FAST ≥ 0.67 was used to rule in the presence of NASH-F, FAST < 0.35 was used to rule out NASH-F, and FAST between 0.35-0.67 was considered indeterminate. Nominal and continuous variables were analyzed with chi-squared and 2-sided T-tests, respectively.Results: A total of 198 patients with T2DM were identified, 107 (71.8%) were female, 79 (69.8%) were Hispanic, 149 (75.6%) had hypertension, 167 (84.3%) had hyperlipidemia, and 167 (84.3%) had metabolic syndrome (MetS). A total of 36 (18.2%) had high FAST indicating the presence of NASH-F, while 86 (43.4%) had low FAST, and 76 (38%) were indeterminate. When compared to the rest of the cohort, patients who had high FAST were younger (51.5 vs 58.2, p=0.01), had higher BMI (36.9 vs 33.9, p< 0.01), higher ALT (96.5 vs 43.4 p< 0.01), higher bilirubin (0.76 vs 0.51, p=0.01), higher LDL (111.3 vs 89.6, p< 0.01), and lower platelets (253.0 vs 284.8, p=0.05). Diabetics with high FAST were not more likely to have hypertension or metabolic syndrome compared to those with low FAST.Discussion: The FAST score identified 18% of diabetic patients with NASH-F who would qualify for pharmacotherapy. While 43% of patients can be stratified as low risk by using a cutoff value of 0.35, 38% of patients had intermediate FAST score values indicating the need for further workup. Strategies to use the FAST score in diabetics with fatty liver should be considered to identify patients with NASH-F.Disclosures:Pankaj Aggarwal indicated no relevant financial relationships. Tamneet Singh indicated no relevant financial relationships. Allison Harrington indicated no relevant financial relationships. Oladuni Cummings-John indicated no relevant financial relationships. Anita Kohli: Akero, Allergan, Axcella, BMS, Cirius Therapeutics, Cymabay, Gilead, Genfit, Genentech, Enanta, Enyo, High Tide, – Grant/Research Support. Gilead, Novartis and Intercept – Advisory Committee/Board Member. Intercept and Merck – Speaker's Bureau. Intercept, Madrigal, Metacrine NGM, North Sea, Novartis, Novo Nordisk, Viking, and Zydus – Grant/Research Support.Mazen Noureddin: Anaetos, Viking – Stockholder/Ownership Interest (excluding diversified mutual funds). BMS, Galmed, Genfit, Galectin, Conatus, Enanta, Novartis, Shire, Zydus – Grant/Research Support. Gilead, Allergan – Advisory Committee/Board Member, Grant/Research Support. Intercept, Pfizer, Novartis, Blade, Echosens North America, OWL, Siemens, Roche Diagnostic, Abbott – Advisory Committee/Board Member.Naim Alkhouri: Allergen – Advisory Committee/Board Member, Grant/Research Support. Galmed – Grant/Research Support. Genfit – Grant/Research Support. Intercept – Advisory Committee/Board Member, Grant/Research Support, Speaker's Bureau. Madrigal – Grant/Research Support.

P2510 (S1200). Roux-En-Y Gastric Bypass Is Associated With Higher Rates of Barrett’s Esophagus and Esophageal Adenocarcinoma When Compared to Laparoscopic Sleeve Gastrectomy: Findings of a Nationwide Analysis With Long-Term Follow-Up 1390006 Mohannad Abou Saleh Cleveland Clinic Foundation Roux-En-Y Gastric Bypass Is Associated With Higher Rates of Barrett’s Esophagus and Esophageal Adenocarcinoma When Compared to Laparoscopic Sleeve Gastrectomy: Findings of a Nationwide Analysis With Long-Term Follow-Up Obesity ePoster Session Mohannad Abou Saleh, MD1, Emad Mansoor, MD2, Adrian Lindsey, MD2, Amit Bhatt, MD1, Siva Raja, MD1, Sudish Murthy, MD, PhD1, Scott Gabbard, MD1, Motasem Alkhayyat, MD1, Carlos Roberto Simons-Linares, MD, MSc1, Amitabh Chak, MD3, Prabhleen Chahal, MD1; 1Cleveland Clinic Foundation, Cleveland, OH; 2University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH; 3University Hospitals of Cleveland, Cleveland, OHIntroduction: Obesity is thought to be a risk factor for esophageal malignancy. The association between bariatric interventions and esophageal malignancy remains unclear. We aim to examine the rates of Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC) in obese patients and in those who underwent roux-en-y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB).Methods: A commercial database (Explorys Inc, Cleveland, OH, USA), consisting of EHR data from 26 US healthcare systems, was surveyed. After excluding bariatric surgery, a cohort of patients with Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) diagnosis of obesity (1999-2020) was identified. Within the obesity cohort, patients who developed new diagnoses of BE and EAC were identified. Subsequently, several cohorts of patients who underwent RYGB, LSG and LAGB were identified. The rates of new diagnoses of BE and EAC after at least 30 days of RYGB, LSG or LAGB were calculated. Risks were compared using univariable analysis.Results: Of 72,531,460 patients in the database, 4,699,470 (6.5%), 230,300 (0.31%), and 10,950 (0.02%) with obesity, BE and EAC were identified respectively. There were 24,630 (0.03%) RYGB, 32,360 (0.05%) LSG and 8,650 (0.01%) LAGB. A total of 240 (0.97%), 110 (0.34%) and 70 (0.81%) of BE were identified after at least 30 days of RYGB, LSG and LAGB. A total of 20 (0.08%), 5 (0.02%), and 5 (0.06%) of EAC cases were identified after at least 30 days of RYGB, LSG and LAGB. Patients who underwent RYGB were more likely to develop BE and EAC when compared to patients who underwent LSG. Patients who underwent LSG were less likely to develop BE when compared to obese patients (Table 1). History of baseline GERD (prior to surgery) and cholecystectomy were associated with increased risk of BE after surgery (Table 2). Prevalence rates of BE over time after surgery are presented in Figures 1.Discussion: Explorys rounds to the closest 0 or 10 to protect patient identity. This did not allow for further analysis of EAC. There is also potential selection and confounding biases. However, this is the largest study to evaluate the risk of BE and EAC in RYGB, LSG and LAGB. RYGB patients had higher risks of BE and EAC when compared to LSG. Longer duration of GERD in the RYGB population prior to surgery may explain this finding. The significant anatomical alteration and physiological changes may also contribute to these findings.Table 1. Risk of Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC) in roux-en-y gastric bypass (RYGB) vs. obesity (no bariatric surgery), RYGB vs. laparoscopic sleeve gastrectomy (LSG), RYGB vs. laparoscopic adjustable gastric banding (LAGB), LSG vs. obesity (no bariatric surgery), LSG vs. LAGB, and LAGB vs. obesity (no bariatric surgery). *P-value not significant.Table 2. Underlying risk factors of Barrett’s esophagus (BE) after roux-en-y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic adjustable gastric banding (LAGB). *P-value not significantFigure 1. Prevalence of Barrett’s esophagus (BE) after roux-en-y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) over a 10 year follow up. *Explorys rounds to the nearest zero or 1.Disclosures:Mohannad Abou Saleh indicated no relevant financial relationships. Emad Mansoor indicated no relevant financial relationships. Adrian Lindsey indicated no relevant financial relationships. Amit Bhatt indicated no relevant financial relationships. Siva Raja indicated no relevant financial relationships. Sudish Murthy indicated no relevant financial relationships. Scott Gabbard indicated no relevant financial relationships. Motasem Alkhayyat indicated no relevant financial relationships. Carlos Roberto Simons-Linares indicated no relevant financial relationships. Amitabh Chak indicated no relevant financial relationships. Prabhleen Chahal indicated no relevant financial relationships.

P2520 (S1210). Weight Loss Outcomes in Bariatric Surgery Based on Pre-Operative Gastric Emptying: A Retrospective Study 1388654 Steven Delaney Wake Forest Baptist Health Weight Loss Outcomes in Bariatric Surgery Based on Pre-Operative Gastric Emptying: A Retrospective Study Obesity ePoster Session Steven Delaney, MD, Zach Harris, MD, Kenneth Koch, MD, Jared Rejeski, MD; Wake Forest Baptist Health, Winston-Salem, NCIntroduction: The obesity epidemic is predicted to impact half of the United States population within the next decade. Bariatric surgery, including laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB), is the most effective option for severe obesity, with dramatic weight loss results and often complete resolution of comorbid conditions. Many possible reasons for the effectiveness of bariatric surgery exist, with alterations in gastric motility as one of these explanations. Our aim was to determine the interaction between pre-operative gastric emptying rate and the metabolic outcomes after bariatric surgery.Methods: We conducted an IRB approved retrospective study at a tertiary medical center. Patients were included if they had a BMI above 34, were between the ages of 18-70, had undergone either LSG or RYGB, and had nuclear medicine gastric emptying scintigraphy (GET) completed prior to surgery. Patients with gastric or small bowel surgery prior to their weight loss surgery were excluded. Data on weight, HbA1C, and GI symptoms at 0, 6, and 12 months from the time of surgery were extracted from the medical record. Data was analyzed using the t-test with p< 0.05 considered significant.Results: Seventy patients were identified with 32 meeting full inclusion criteria. Patients averaged 50 years old, and 90% were female; 87.5% were Caucasian and 9% were African American. Four-hour GET, showed 68.8% of patients had normal gastric emptying, 3% had rapid emptying, and 28% had delayed emptying. At 12 months, patients with normal 4-hour GET had an average decrease in BMI of 28.1% compared to 31.1% in patients with delayed emptying (p=0.375). Absolute change in HbA1C at 12 months was -0.2 in patients with normal GET compared to -0.8 in patients with delayed GET (p=0.085). Subgroup analysis comparing mild, moderate, and severe delayed emptying also resulted in no difference in weight loss after operations.Discussion: The results of this retrospective analysis indicate that differences in gastric emptying prior to surgery do not impact metabolic outcomes after bariatric surgery. However, more patients with rapid gastric emptying need to be studied given its link to obesity and the physiologic changes to gastric emptying associated with weight loss surgery. Comparing LSG and RYGB in relation to GET may be an additional consideration for future study.Disclosures:Steven Delaney indicated no relevant financial relationships. Zach Harris indicated no relevant financial relationships. Kenneth Koch indicated no relevant financial relationships. Jared Rejeski indicated no relevant financial relationships.

P2530 (S1216). Speech-Language Pathologists Promote Management of Children With Eosinophilic Esophagitis 1388575 Girish Hiremath Vanderbilt University Medical Center Speech-Language Pathologists Promote Management of Children With Eosinophilic Esophagitis Pediatrics ePoster Session Shannon Guarnere, MS, CCC-SLP, CLC1, Caitlin Gogoll, MS, CCC-SLP, CLC2, Melissa Henry, MA, CCC-SLP2, Sari Acra, MD, MPH2, Girish Hiremath, MD, MPH2; 1Vanderbilt Bill Wilkerson Center, Nashville, TN; 2Vanderbilt University Medical Center, Nashville, TNIntroduction: Speech-language pathologists (SLPs) assess feeding and swallowing problems, and provide education and skill-based interventions which can improve clinical outcomes. Children with eosinophilic esophagitis (EoE) frequently present with feeding and swallowing problems. However, the spectrum of these problems has not been well studied. Herein, we sought to characterize the feeding and swallowing disorders and the related interdisciplinary care in children with EoE. We hypothesized that prompt recognition and management of feeding and swallowing problems in children with EoE can promote their clinical care.Methods: We reviewed medical records of 170 children with EoE for feeding and swallowing concerns prior to their visit to our interdisciplinary EGID clinic. Of these, 46 (27%) children were identified and evaluated by SLPs during their clinic visit for dysphagia (oral, pharyngeal, coughing/choking, and aspiration), selectivity (texture aversion, difficulty with texture advancement, limited variety of food groups), and meal time behaviors (refusal, extensive duration, need for distractions, pocketing food, and caregivers stress). Next, the SLPs provided specific dietary guidance, skill acquisition and behavioral management strategies, additional testing, or an intensive outpatient feeding evaluation. Descriptive statistics were used to analyze data.Results: The age of our cohort was 10 (1.8-18) years [median (interquartile range (IQR))]. In all 22 (51%) [n (%)] had dysphagia, 22 (51%) reported selectivity, and 18 (41%) indicated negative meal time behaviors. Dysphagia was more prevalent in older children [13 (7-16) years], whereas selectivity [9 (5-12) years] and meal time behavior [9 (6-12) years] were common in relatively younger children with EoE. Twenty-two (48%) children were offered dietary guidance on alternating liquids/solids and puree/liquid wash, 22 (48%) were educated on sensory exploration/food chaining, and 18 (39%) were instructed on behavior management strategies. Three (7%) were advised video fluoroscopic swallow study. In all, 22 (48%) were referred for an intensive outpatient evaluation.Discussion: In our single center study, we found that almost a third of children with EoE experience feeding and swallowing problems, and about half of them require intensive feeding evaluation. A large multi-center approach to integrate SLPs in the care of EoE patients is warranted to promote clinical outcomes.Disclosures:Shannon Guarnere indicated no relevant financial relationships. Caitlin Gogoll indicated no relevant financial relationships. Melissa Henry indicated no relevant financial relationships. Sari Acra indicated no relevant financial relationships. Girish Hiremath indicated no relevant financial relationships.

P2550 (S1233). Winning Abstracts From the 2019 American College of Gastroenterology Annual Scientific Meeting: Impacting Factors and Fate 1390461 Mohammad Alomari Cleveland Clinic Florida Winning Abstracts From the 2019 American College of Gastroenterology Annual Scientific Meeting: Impacting Factors and Fate Practice Management ePoster Session Mohammad Alomari, MD1, Rasheed Musa, MD2, Laith Al Momani, MD3, Asif A. Hitawala, MD4, Pravallika Chadalavada, MD5, Shrouq Khazaaleh, MD6, Mohammad Al Waqfi, MD7, Mohammad Shannag, MD7, Lana Makahleh, MD8, Fredy Nehme, MD3, May Olayan, MD4; 1Cleveland Clinic Florida, Weston, FL; 2East Tennessee State University, Johnson City, TN; 3University of Missouri, Kansas City, MO; 4Cleveland Clinic Foundation, Cleveland, OH; 5Cleveland Clinic Foundation, Rocky River, OH; 6Cleveland Clinic Foundation, Johnson City, TN; 7Royal Free London NHS Foundation Trust, London, England, United Kingdom; 8University of Jordan, Amman, Amman, JordanIntroduction: Abstracts submitted for presentation to any national meeting undergo rigorous peer review to identify the ones with the most important scientific information. While most abstracts are presented as posters, a few top-ranking abstracts gain wider publicity at the podium and also receive awards as a mark of recognition for the importance of those studies. No prior study has analyzed the factors associated with receiving an award at the ACG meeting and the fate of these award-winning abstracts. Hence, we sought to assess the factors associated with a higher likelihood of receiving a presidential poster award at the 84th scientific meeting of ACG held in San Antonio, TX.Methods: We evaluated all abstracts presented at the ACG 2019 meeting using the online eventScribe. All the abstracts were divided into two categories: award winning and award non-winning. We performed a systematic search for matching manuscripts indexed in PubMed and MEDLINE databases using the first author's name and keywords from the abstract. Fisher’s exact test and Pearson's chi-square tests were used to compare median of continuous and categorical variables, respectively. All comparisons were two-sided.Results: A total of 304 abstracts were analyzed. Among them, 154 (50.6%) were award winning. The abstract to manuscript publication rate was higher in the award-winning group when compared to award non-winning group (10.3% vs. 2.6%, p=0.01). The median impact factor of the published journal was 3.9 in the award-winning group in contrast to 2.1 in the award non-winning group. A significantly higher percentage of the abstracts that received awards had a positive study outcome when compared to those that did not. (61.6% vs. 40.6%, p=0.0001). 60.3% of the award-winning abstracts had an attending physician as the first author, while 46.6% of the award non-winning abstracts had a resident as the first author (p< 0.0001). There was no difference between the type of research and first author affiliation among both the groups. (Table 1)Discussion: The presence of a positive outcome and an attending physician as a first author were associated with a higher chance of receiving an award at the ACG meeting. Strikingly, the abstract to publication rate was also higher in the award-winning group with no observed impact for the study type and the author affiliation in award wining decision. That demonstrates that rigorous merit-based award selection process and invites for more high quality research submissions to ACG meeting.Table 1. Comparison of baseline factors among award winning and award non-winning abstracts at the ACG scientific meeting in 2019.Disclosures:Mohammad Alomari indicated no relevant financial relationships. Rasheed Musa indicated no relevant financial relationships. Laith Al Momani indicated no relevant financial relationships. Asif Hitawala indicated no relevant financial relationships. Pravallika Chadalavada indicated no relevant financial relationships. Shrouq Khazaaleh indicated no relevant financial relationships. Mohammad Al Waqfi indicated no relevant financial relationships. Mohammad Shannag indicated no relevant financial relationships. Lana Makahleh indicated no relevant financial relationships. Fredy Nehme indicated no relevant financial relationships. May Olayan indicated no relevant financial relationships.

P2560 (S1243). Superior Quality Indicators for Colonoscopies Scheduled by Open Access Compared to GI-Office: It Is Time to Expand Its Use During the COVID-19 Crisis! 1388744 Nihita Manem Albany Medical Center Superior Quality Indicators for Colonoscopies Scheduled by Open Access Compared to GI-Office: It Is Time to Expand Its Use During the COVID-19 Crisis! Practice Management ePoster Session Nihita Manem, BS1, Katherine Donovan, BS2, David Miller, BS1, Ghassan Kabbach, MD2, Michael Tadros, MD, MPH, FACG1; 1Albany Medical Center, Albany, NY; 2Albany Medical College, Albany, NYIntroduction: Open access (OA) colonoscopies are defined as those scheduled without a GI office visit. OA is becoming more routine, as it can decrease cost of unnecessary office consultations. One issue related to OA procedures is patient acceptance and preparedness for procedures. However, there is limited research on adequacy of bowel preparation (BP), patient compliance, and detection of adenomas in OA colonoscopies.Methods: This study was a cross-sectional study of 60 patients using split BP for colonoscopies. Patient consent was obtained, and surveys were administered before procedures. Patient age, BMI, gender, education level, prior c-scope and constipation history were collected. Patient compliance with the prep was self-reported. BP adequacy and adenomas detected were recorded. Adequate BP was defined as excellent and good, and inadequate BP was defined as fair and poor. Patients were asked three questions on a scale from 1 to 5 qualifying the BP instructions (Table 1). 5 indicated complete agreement with the statement and 1 indicated no agreement. SPSS was utilized to analyze the data using chi square and Mann-Whitney tests.Results: Complete data for BP adequacy was collected for 56/60 patients. 21 participants (38%) were scheduled by OA, and 35 participants (62%) were scheduled after GI-office visit. Adequate BP was more frequent in 86% (18/21) of patients in the OA group compared to 60% (21/35) of patients in the GI-office group (P=0.043). Patients in the OA group had higher self-reported compliance and adenoma detection but were not significant (Figure 1). There was no statistical difference between the OA and GI-office groups for age, BMI, gender, education level, history of constipation, and prior c-scope (Table 2). OA group patients reported better review and explanation of the BP instructions compared to GI-office patients. No statistical difference was found in how well the patients understood the importance of BP (Table 1).Discussion: This study has shown that OA colonoscopies were associated with more adequate bowel preparation. This could be explained by patients’ self-motivation or more time spent reviewing and explaining the significance of completing BP. This study supports the use of OA procedures as a standard of care, especially during the COVID-19 pandemic, which is causing a significant disruption in normal office operations. It also supports the notion that BP adequacy may start with spending sufficient time discussing split prep instructions with patients.Figure 1. Quality of bowel prep, patient self-reported compliance, and adenomas detection among the Open access group and GI office group . 86% of patients in the OA group had adequate bowel prep compared to 60% of patients in the GI-office group (P=0.532). 73% of patients in the OA group were compliant compared to 65% of patients in the GI-office group. (P=0.043). 38% of patients in the OA group had adenomas detected compared to 28% of patients in the GI-office group (P=0.419).Table 1. Mean rank and p-values comparing OA vs GI-office for the 3 qualifying questions regarding comprehension of Bowel Prep instructions Table 2. Demographics of patient populationDisclosures:Nihita Manem indicated no relevant financial relationships. Katherine Donovan indicated no relevant financial relationships. David Miller indicated no relevant financial relationships. Ghassan Kabbach indicated no relevant financial relationships. Michael Tadros indicated no relevant financial relationships.

P2570 (S1253). A Quality Improvement Project to Improve Standard of Care for Severe and Fulminant Clostridioides difficile Infection 1388094 Yichun Fu Icahn School of Medicine at Mount Sinai A Quality Improvement Project to Improve Standard of Care for Severe and Fulminant Clostridioides difficile Infection Practice Management ePoster Session Yichun Fu, MD, Yuying Luo, MD, Sally Engelman, MPH, Ying Qiu, MS, Ari M. Grinspan, MD; Icahn School of Medicine at Mount Sinai, New York, NYIntroduction: Severe and fulminant Clostridioides difficile infection (CDI) is associated with significant morbidity and mortality. Standard of care (SOC) includes oral vancomycin and intravenous metronidazole with optional vancomycin per rectum. In adult patients with severe and fulminant CDI at a tertiary academic center, we aimed to increase the number of patients who received SOC antibiotics via a quality improvement (QI) project. Methods: Our project was approved by the QI committee in the Department of Medicine at Mount Sinai Hospital. Education sessions were held to disseminate information on an existing CDI order set and treatment algorithm. The sessions emphasized on recognizing patients with severe and fulminant CDI and SOC management. We targeted primary providers in intensive care, emergency department and ward teams. Pre-intervention (January to April 2019) and post-intervention (January to April 2020) metrics were gathered via the electronic health record. Our primary outcomes were usage and timeliness of the initial dose of SOC antibiotics; secondary outcomes included order set usage and length of stay. Student’s T-test and Fisher’s exact test were used in statistical analysis.Results: Eight education sessions were held between January to March 2020 with 129 participants (One session was virtual due to the COVID-19 pandemic, Table 1). 26 severe and fulminant cases were identified in the pre-intervention period and 33 in the post-intervention group (p=0.52, Table 2). There was no significant difference in the demographics and comorbidities of the two groups. The patients had comparable white blood cell counts (median 19.4 vs 18.0, p=0.16), creatinine (1.58 vs 1.74, p=0.38) and pressor use (7.7% vs 24.2%, p=0.16). There was a non-significant increase in appropriate and timeliness of antibiotics usage in our post-intervention group (92.3% vs 97.0%, p=0.58, Table 3). There was a trend toward a lower mortality rate (26.9% vs 9.1%, p=0.08) and length of stay (12 vs 10 days, p=0.12) in the post-intervention group.Discussion: Education sessions to promote a standardized order set and treatment algorithm for severe and fulminant CDI may improve recognition of this disease as well as adherence to standard of care treatment. There was increased understanding of clinical manifestation and appropriate antibiotic management. A larger cohort of patients and longer study period is needed to determine its effectiveness and durability.Table 1. Education sessions on C. difficile infection management. ICU, intensive care unit.Table 2. Non-severe, severe and fulminant C. difficile infections per month 2019 vs 2020. There were comparable number of severe and fulminant cases between pre-intervention and post-intervention (p=0.52).Table 3. Management and outcome of severe and fulminant C. difficile infections in 2019 and 2020. IV, intravenous; FMT, fecal microbial transplant; IQR, interquartile range.Disclosures:Yichun Fu indicated no relevant financial relationships. Yuying Luo indicated no relevant financial relationships. Sally Engelman indicated no relevant financial relationships. Ying Qiu indicated no relevant financial relationships. Ari Grinspan indicated no relevant financial relationships.

P2580 (S1263). Effect of Automated Reminders on Procedure Completion in a Safety Net Population 1390317 Shreya Patel University of California San Francisco Effect of Automated Reminders on Procedure Completion in a Safety Net Population Practice Management ePoster Session Shreya Patel, MD, MPH1, Phuong Tran, MS2, Heather Burske, BA2, Angel Espinoza, RN3, Carly Rachocki, MPH4, Ma Somsouk, MD, MAS1; 1University of California San Francisco, San Francisco, CA; 2CipherHealth, New York, NY; 3San Francisco Department of Public Health, San Francisco, CA; 4Alameda Country Behavioral Health, Oakland, CAIntroduction: Preventing “no-shows” for gastrointestinal endoscopy procedures is an important opportunity for improving patient care, reducing costs, and increasing efficiency. However, most navigation-based interventions such as nurse calls or pre-procedure classes are labor intensive and can be challenging in a safety-net population. This study examined the effect of automated text and voice outreach on show rate for endoscopy.Methods: All patients scheduled for outpatient endoscopic procedures between December 12, 2019 and March 13, 2020 at our safety-net hospital were sent automated reminders either as a text message or voice call in English, Spanish, or Chinese per patient selection. Seven days before their appointment, patients were asked to confirm or offered the opportunity to reschedule, with a reminder to pick up their laxative prescription if appropriate. The day before the procedure, for endoscopy, patients were reminded to remain NPO past midnight, and for colonoscopy, were provided instructions on clear liquid diet and completing the split-dose laxative. The primary outcome was the show rate. Secondary outcomes were show rates by patient response, gender, language, and age.Results: 1,244 unique patient appointments occurred after excluding those who cancelled (n=28) or were deceased (n=2). Outreach was conducted in English (76%), Spanish (16%), and Chinese (8%). Overall, the show rate was 60%. 726 (58%) patients responded to outreach with 14% of patients (99) requesting rescheduling and 86% of patients (627) confirming their appointment. Confirmed appointments were associated with increased show rates compared to patients who did not confirm (75% vs. 49%, P < 0.001). Patients who confirmed their appointment were more likely to be female (63% vs 55%, P < 0.007), younger (75% for those ≤ 40 years old vs 52% for those ≥ 60 years old, P < 0.001), non-Chinese speaking (50% vs 62%, P < 0.005), and have received voice calls compared to text (75% vs 51%, P < 0.001). Among patients who confirmed, show rates increased by 8 percentage points with voice calls, 24 points with text messaging, 48 points in patients ≤ 40 years old, and 21 points in men compared to those who did not confirm.Discussion: Patients in a safety-net system who confirmed their appointment with automated reminders were more likely to attend their scheduled appointments. This low-cost approach is an efficacious method of improving no-show rates for endoscopy.Disclosures:Shreya Patel indicated no relevant financial relationships. Phuong Tran indicated no relevant financial relationships. Heather Burske indicated no relevant financial relationships. Angel Espinoza indicated no relevant financial relationships. Carly Rachocki indicated no relevant financial relationships. Ma Somsouk indicated no relevant financial relationships.

P2590 (S1273). Are There Differences in the Academic Productivity Between Female and Male GI Fellowship Program Directors? 1390606 Dheera Grover University of Connecticut Are There Differences in the Academic Productivity Between Female and Male GI Fellowship Program Directors? Practice Management ePoster Session Dheera Grover, MD1, Vibhor Wadhwa, MD2, Mohammad Bilal, MD3, Tyler M. Berzin, MD4, John Vargo, MD, FACG5, Fernando J. Castro, MD6, Vaibhav Wadhwa, MD6; 1University of Connecticut, Hartford, CT; 2University of Arkansas for Medical Sciences, Little Rock, AR; 3Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; 4Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; 5Cleveland Clinic Foundation, Cleveland, OH; 6Cleveland Clinic Florida, Weston, FLIntroduction: The gastroenterology (GI) fellowship program directors (PDs) play a pivotal role in running the fellowship program. The purpose of this study was to analyze the demographic characteristics, academic background and scholarly activities of GI fellowship director workforce in the United States (US)Methods: A list of all Accreditation Council for Graduate Medical Education (ACGME) accredited adult GI fellowship programs was obtained. PDs of all programs were included in the study. Publicly available sources were used to gather information about each PD, including the individual program websites, HealthGrades and Doximity websites, Scopus database. The variables collected included age, sex, educational background, fellowships of GI societies (AGAF, FASGE, FACG, FAASLD) and scholarly metrics. Non-parametric statistics including Mann-Whitney U and Kruskal Wallis tests were applied to compare the groupsResults: A total of 207 GI PDs from 207 adult GI fellowship programs were included, of which 159 (76.8%) were males. Female PDs were significantly younger than male PDs (median age 45.5 vs 53 years, p< 0.001). The mean age at appointment of PDs was 45.5 years and the mean duration served as PD was 6.4 years. Majority of PDs graduated from North American medical schools (81%). General gastroenterologists comprised 79% of PDs, while the rest had specialized in hepatology (12%), advanced endoscopy (6%), IBD (2%), and gastric motility (1.0%). Majority of PDs (63.2%) were fellows of a professional GI society. The mean publications, citations and h-index were 37.324±66.51, 1512.57±3820.82 and 12.03±18.27, respectively. No difference was observed in scholarly activities when stratified by sex. Academic rank was available for 113 individuals, amongst which 37 were assistant professors, 43 associate professors and 33 were professors. There was statistically significant increase in scholarly metrics with higher academic rank. Advanced endoscopists and hepatologists had significantly higher scholarly metrics compared to general gastroenterologists.Discussion: While there is no difference in scholarly metrics between current male and female PDs and APDs, gender disparities exist in leadership roles in GI fellowship programs. Efforts should be made to bridge this gap.Figure 1: Demographics of PDs – by gender (a) and by age* (b).Disclosures:Dheera Grover indicated no relevant financial relationships. Vibhor Wadhwa indicated no relevant financial relationships. Mohammad Bilal indicated no relevant financial relationships. Tyler Berzin indicated no relevant financial relationships. John Vargo indicated no relevant financial relationships. Fernando Castro indicated no relevant financial relationships. Vaibhav Wadhwa indicated no relevant financial relationships.

P2610 (S1292). Probiotic Use in Celiac Disease: Results from a National Survey 1390129 Andrew Joelson Columbia University Medical Center Probiotic Use in Celiac Disease: Results from a National Survey Small Intestine ePoster Session Andrew M. Joelson, MD1, John W. Blackett, MD1, Rebecca Molinsky, BS2, Marilyn Geller, BA, MSPH3, Peter H. Green, MD1, Benjamin Lebwohl, MD, MS4; 1Columbia University Medical Center, New York, NY; 2University of Minnesota, Minneapolis, MN; 3Celiac Disease Foundation, Woodland Hills, CA; 4New York-Presbyterian/Columbia University Medical Center, New York, NYIntroduction: Probiotic use is common, despite relatively few indications for their use. There is no current evidence to support probiotic use in Celiac Disease (CD) and limited understanding of why probiotics are used in this group. Using a national registry, we aimed to characterize the prevalence and predictors of probiotic use among CD patients.Methods: We analyzed data from iCureCeliacTM; a voluntary, patient-powered research network questionnaire distributed by the Celiac Disease Foundation. We included adults (≥18 years) with self-reported, biopsy-diagnosed CD who answered questions regarding basic demographics, diagnosis, symptoms, treatment, Short Form Survey 36 (SF36), and celiac disease quality of life score (CDQOL). We compared probiotic users versus probiotic non-users and performed multivariable logistic regression, assessing for independent predictors of probiotic use.Results: 4909 patients met criteria for inclusion. Of these, 1160 (23.6%) responded to a question regarding probiotic use. The mean age was 38.8 years and 82% were female. 381 patients (33%) reported using probiotics. 47% of probiotic users were over the age of 60 and 47% were diagnosed with CD after the age of 50. More probiotic users sought nutritional counseling at time of diagnosis (36% vs. 30%, p=0.05) and remained symptomatic despite a gluten-free diet (40% vs. 25%, p< 0.001). Probiotic users had significantly lower scores on the pain subscale of the SF36 (63.7±21.6 vs. 69.5±22.1, p=0.006) suggesting more physical pain. On multivariate analysis, patients diagnosed after the age of 50 (OR 2.04, 95%CI 1.37-3.04), and those with persistent symptoms despite a gluten-free diet (OR 1.94, 95%CI 1.44-2.63) were more likely to use probiotics. Compared to those diagnosed in young adulthood (20-29 years), patients diagnosed between ages 11-19 were less likely to use probiotics (OR 0.50, 95%CI 0.29-0.85).Discussion: In this large study of a national CD registry, we found that roughly one-third of CD patients reported using probiotics. Patients diagnosed later in life were more likely to use probiotics. Those who remained symptomatic despite a gluten free diet were twice as likely to take probiotics, compared with those reporting symptom control. Patients may be seeking additional means of treatment for persistent symptoms. Further study is needed to clarify if these symptoms are related to accidental gluten ingestion and to evaluate any benefit of using probiotics in symptoms or quality of life in the CD population.Table 1. Independent Predictors of Probiotic Usage Among Celiac Disease PatientsDisclosures:Andrew Joelson indicated no relevant financial relationships. John Blackett indicated no relevant financial relationships. Rebecca Molinsky indicated no relevant financial relationships. Marilyn Geller indicated no relevant financial relationships. Peter Green indicated no relevant financial relationships. Benjamin Lebwohl indicated no relevant financial relationships.

P2620 (S1302). Follow-Up Outcomes in Celiac Disease Patients Followed at a Large, Community-Based Gastroenterology Practice 1389075 Akash Khurana University of Illinois College of Medicine Follow-Up Outcomes in Celiac Disease Patients Followed at a Large, Community-Based Gastroenterology Practice Small Intestine ePoster Session Akash T. Khurana, BS1, Daniel Leffler, MD2, Chandrashekhar Thukral, MD, PhD3; 1University of Illinois College of Medicine, South Barrington, IL; 2The Celiac Disease Center at Beth Israel Deaconess Medical Center / Harvard Medical School / Takeda Pharmaceuticals, Boston, MA; 3Rockford Gastroenterology Associates, Ltd., University of Illinois College of Medicine, Rockford, ILIntroduction: Celiac disease (CD) is a chronic illness caused by an immune response to gluten and diagnosed with anti-tissue transglutaminase antibody testing and duodenal biopsies. Treatment is adherence to a gluten-free diet (GFD) which requires effective patient education, motivation, and frequent follow-up visits. Guidelines from prior studies in large academic settings recommend dietician referrals at time of diagnosis and periodic testing for micronutrient deficiencies. However, there is limited data to guide practice parameters in a community-based practice. The purpose of this study was to evaluate guideline adherence by community-based gastroenterologists.Methods: We assessed CD care based on follow-up rates, micronutrient testing, symptoms and serology results in cohorts with and without dietician referrals. This retrospective study analyzed patients at Rockford Gastroenterology Associates (RGA), in Rockford, IL: a large private practice of 14 gastroenterologists and 7 nurse practitioners. Patients were included if they had a diagnosis from January 1, 2014 through December 31, 2018, based on positive serology and/or biopsy. Patient data was collected by chart review and analyzed through Microsoft Excel and SPSS.Results: A cohort of 126 patients (84 female) met inclusion criteria. 69.8% had a dietician referral order. 65.9% had at least one lab test order for any of the 6 micronutrients (Table 1). Of the 80.2% that attended at least one follow-up appointment, 34.9% had only one and 19.8% had only two (Figure 1). A smaller cohort (79 patients), excluding those without follow-up symptom or serology data, was used for separating patients into 4 categories (Figure 2). Although patients with a referral had a higher proportion (32% vs 26%) in the asymptomatic and negative serology category, this was not statistically significant based on a fisher exact test value of 2.62 (p=.466).Discussion: Dietician referral, micronutrient testing, and close follow-up are important parameters that affect outcomes in CD patients. The rates for dietician referral, some micronutrient testing and follow-up visits were higher than 50% in this study. Although a greater percentage of patients with a dietician referral were asymptomatic and had negative serology, this was not statistically significant. A larger, long-term study is needed to assess clinical outcomes in these patients and modify guidelines for the feasibility and practicality of multiple lab testing and follow-up care in community-based practice.Table 1. Micronutrient orders and testing rates at follow-up.Figure 1. Time interval between time of diagnosis and follow-up visits.Figure 2. Categorization of patients by symptoms and serology results.Disclosures:Akash Khurana indicated no relevant financial relationships. Daniel Leffler: Takeda Pharmaceuticals – Employee, Medical Director.Chandrashekhar Thukral indicated no relevant financial relationships.

P2630 (S1312). Time Trends of Micronutrient Deficiencies in Newly Diagnosed Celiac Disease: A Story of Denominators 1390101 Giovanni Roldan University of Miami, Jackson Memorial Hospital Time Trends of Micronutrient Deficiencies in Newly Diagnosed Celiac Disease: A Story of Denominators Small Intestine ePoster Session Giovanni A. Roldan, MD1, Daniela Goyes, MD2, Melinda Dennis, RD3, Ciaran P. Kelly, MD2, Javier A. Villafuerte Galvez, MD2; 1University of Miami, Jackson Memorial Hospital, Miami, FL; 2Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; 3Beth Israel Deaconess Medical Center, Boston, MAIntroduction: A classical presentation of Celiac Disease(CeD)would often include diarrhea, bloating, and deficiency of micronutrients such as iron, folate, or vitamin B12. Studies prior to 2000 reported folate deficiency in 42-84% of patients with a new diagnosis of CeD. In contrast, more recent studies found folate deficiency in 20% in this group. We aimed to study the changes over time in the frequency of micronutrient deficiencies in newly diagnosed CeD patients from a prospectively maintained single-center cohort.Methods: A total of 1547 patients ≥18 years of age with biopsy-confirmed newly diagnosed CeD between 2000 and 2016 were identified. The cohort was divided into four groups according to the year of diagnosis. Following published literature, iron deficiency was defined with ferritin level < 30 ng/mL. Folate and vitamin B12 deficiencies were defined by levels < 7ng/dL and < 240pg/mL, respectively. The age and gender differences between groups were tested using ANOVA. Proportions over time were correlated with time periods with the Spearman method. Changes over time of ferritin, folate, and B12 were assessed with linear regressions. Log transformation was performed if not normally distributed.Results: Age and gender did not vary across time periods(Table 1). The median serum ferritin varied across time periods(p< 0.01). Among patients tested for micronutrient deficiencies upon CeD diagnosis, the proportion of patients with folate, iron and B12 deficiency decreased over the four studied time periods(rho=-1.0,p< 0.001 for all three). The intensity of micronutrient testing increased significantly over time for iron and B12(rho=+1.0,p< 0.001, both) but no significant difference was found for folate(rho=+0.8,p=0.2) (Table 2). Among those newly diagnosed with CeD, the proportion of patients with B12 deficiency decreased over time(rho=-1.0,p< 0.001)but folate(rho=-0.2,p=0.8) and iron deficiency(rho=-0.4,p=0.6)did not(Table 1 and Figure 1).Discussion: In our cohort, we observe a change of practice towards testing more frequently for micronutrient deficiencies such as iron and B12 at the diagnosis of CeD. The changes in intensity of testing create an inaccurate impression of decreasing prevalence of iron and folate deficiencies. However, a decrease in the prevalence of B12 deficiency is observed despite intensity of testing in our cohort. This phenomenon could be attributed to residual confounding, increased B12 supplementation prior to diagnosis, or another unmeasured change in patient populations.Table 1. Cohort characteristics and micronutrient deficiencies at diagnosis of Celiac Disease.Table 2. Intensity of micronutrient testing at diagnosis of Celiac Disease.Figure 1. Proportion of patients with folate (A), iron (B) or B12 (C) testing and deficiencyDisclosures:Giovanni Roldan indicated no relevant financial relationships. Daniela Goyes indicated no relevant financial relationships. Melinda Dennis indicated no relevant financial relationships. Ciaran Kelly indicated no relevant financial relationships. Javier Villafuerte Galvez indicated no relevant financial relationships.

P2790 (S1323). Optimal Parameters of Gastric Electrical Stimulation for Long-Term Symptom Control in Patients With Gastroparesis 1388880 Alexandra Willauer University of Cincinnati Optimal Parameters of Gastric Electrical Stimulation for Long-Term Symptom Control in Patients With Gastroparesis Stomach ePoster Session Alexandra N. Willauer, MD1, Karina Espino, MS2, Luis Alvarado, MS2, Alok Dwivedi, MSc, PhD3, Tariq S. Siddiqui, MD2, Richard McCallum, MD, FACG2, Irene Sarosiek, MD2; 1University of Cincinnati, Cincinnati, OH; 2Texas Tech University Health Sciences Center, El Paso, TX; 3Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, TXIntroduction: Gastric electrical stimulation (GES) with Enterra therapy is indicated for the treatment of drug-refractory gastroparesis (GP) symptoms. However, there is limited literature on recommended stimulation parameters and their association with long-term clinical outcomes. Our goal was to evaluate the differences in GES parameters and GP total symptom score (TSS) in 2 etiological groups of gastroparetic patients at the time of GES introduction and during follow-up visits.Methods: Fifty-seven GES patient records were retrospectively reviewed. An interrogation of the GES system and assessment of GP symptoms were performed at the initiation of GES therapy and during follow-up visits. The default stimulation parameters remaining constant included a frequency of 14 Hz, a pulse width of 330 μs and an ON/OFF time of 0.1s/5s. The variable stimulation parameters were voltage, impedance/resistance, and current. A 5-point Likert scale (0 - absent, 1 - mild, 2 - moderate, 3 - severe, and 4 - extremely severe) was utilized to assess the following GP symptoms: vomiting, nausea, early satiety, bloating, postprandial fullness, and abdominal pain. The TSS was calculated by adding the scores of the 6 GP symptoms with a maximum score of 24. At each follow-up visit, the GES parameters of voltage (V) and current (I) were adjusted based on the patient’s clinical presentation and recorded impedance value (R; normal range of 200-800 Ω).Results: The mean age of patients was 44 ± 14 years, and 72% were female. The etiology for GP was diabetes mellitus in 72% and 28% were idiopathic. The mean duration of GP before the introduction of GES was 6 ± 4 years. The median time of follow-up visit was 47 months (range 5-73 months). A significant decrease was found within each individual symptom score along with the TSS at the most recent follow-up visit compared to the baseline (P < 0.0001 for all). Impedance (P < 0.0001), voltage (P < 0.0001), and current (P=0.0001) increased significantly in the follow-up visit compared to the baseline visit (Table 1). There were no significant differences found between GES parameters in diabetic vs. idiopathic patients (Table 2).Discussion: These findings suggest that a conservative approach to setting GES parameters yields optimal and sustained symptomatic control in GP patients regardless of their etiology. This “classic” programming of the system prevents early depletion of the device batteries, which allows longer utilization of GES therapy.Table 1: Comparison of variable device stimulation parameters between baseline and the most recent follow-up visit. Device stimulation parameters reported as mean (standard deviation, or SD).Table 2: Comparison of follow-up GES parameters and total symptom score based on the etiology of gastroparesis. Device stimulation parameters and total symptom score reported as mean (standard deviation, or SD).Disclosures:Alexandra Willauer indicated no relevant financial relationships. Karina Espino indicated no relevant financial relationships. Luis Alvarado indicated no relevant financial relationships. Alok Dwivedi indicated no relevant financial relationships. Tariq Siddiqui indicated no relevant financial relationships. Richard McCallum indicated no relevant financial relationships. Irene Sarosiek indicated no relevant financial relationships.

P2800 (S1333). Integrative Analyses Reveal Bile Acid Receptors Are Novel Prognostic Markers for Gastric Cancer 1388231 Michael Rohr University of Central Florida College of Medicine Integrative Analyses Reveal Bile Acid Receptors Are Novel Prognostic Markers for Gastric Cancer Stomach ePoster Session Award: Presidential Poster AwardMichael W. Rohr, BA1, Jihad Aljabban, MD, BSc2, Trina A. Rudeski-Rohr, BA1, Spencer Lessans, BS1, Sai Preethi Nakkina, BS1, Dexter Hadley, MD, PhD1, Deborah Altomare, PhD1; 1University of Central Florida College of Medicine, Orlando, FL; 2University of Wisconsin Hospital and Clinics, Madison, WIIntroduction: Bile acid receptors (BARs) are increasingly being spotlighted as potential drivers of gastrointestinal cancers. Few studies have explored the role BARs play in gastric cancer (GC) tumorigenesis and potential clinical implications, especially as it relates to duodenogastric biliary reflux (DGR). We aggregated transcriptomic data to identify functional and prognostic roles for BARs as novel biomarkers in GC management.Methods: We collected transcriptomic data from The Cancer Genome Atlas, Genome Tissue Expression, and Gene Expression Omnibus repositories. We leveraged unique aspects of each dataset to analyze associations between BARs and GC prognosis, subtype, and clinicopathology. We also utilized ingenuity pathway analysis to assess BAR associated functions and upstream regulators as it relates to GC.Results: BARs showed differential distribution in GC; membrane BARs (GPBAR1, S1PR2, and CHRM2) were enriched in diffuse, genome stable, and mesenchymal-type tumors while nuclear BARs (PXR, CAR, and FXR) expression was mainly unaltered only being elevated metabolic subtypes. Every BAR (except PXR and FXR), was significantly associated with poor prognosis in GC. Membrane, but not nuclear, BARs were also associated with advanced stage, grade, tumor size, treatment failure, and leukocyte infiltration. We found additional associations with H. pylori infection and membrane BARs, which were geographically distributed according to GC mortality rates; enriched in Eastern European and Asian samples. Last, we found genes associated with GC tumorigenesis including EGFR, TGFB1, SMARCA4, SMAD4, NORAD, TEAD1-4, and P38-MAPK as common activated and miR-218, miR-146a-5p, miR-34a-5p, and ETV6-RUNX1 as common inhibited upstream regulators of membrane BARs.Discussion: GC is the fifth most common and third deadliest cancer worldwide, carrying a median survival of less than a year. H. pylori infection remains the top risk factor for developing GC and is a known cause of DGR. However, little is known about the role components of DGR, namely bile acids, plays in GC. In a comprehensive transcriptomic analysis of more than 1500 samples, we identified BARs as prognostically relevant, novel biomarkers associated with unfavorable clinicopathologic features of GC. Specifically, we find compelling evidence that membrane BARs are directly implicated in diffuse GC tumorigenesis, primarily through bile acid induced TGFB1 signaling and downstream EFGR activation as result of DGR.Figure 1. BARs are differentially expressed and are novel prognosticators of GC. Comparative meta-analysis of BAR expression patterns between (A) normal and gastric tumor tissue and (B) between diffuse and intestinal Laurén GC subytpes. Each heat map panel represents the mean difference (MD) of Log2-transformed values. Overall MD was based on inverse variance and random effects weighting. (D) Plot showing median time to first progression based off median low and high BAR expression cutoffs. (E & F) BAR hazard ratios (HRs) for (E) post-progression and (F) overall survival as determined by univariate and multivariate analyses. (G-I) Kaplan-Meier plots comparing percent survival between low and high expression cohorts in intestinal and diffuse-type GC for membrane receptors; (G) GPBAR1, (H) S1PR2, and (I) CHRM2; significance was calculated based of Cox-Mantel regression for univariate analyses, and proportional Cox regression for multivariate analyses. Statistics: *P 1.96.Figure 2. BAR expression is associated with distinct GC molecular signatures and subtypes. (A) Heat map of expression Z-scores across the four TCGA-Molecular GC subtypes and their signatures; microsatellite instability (MSI), Epstein-Barr Virus (EBV), Chromosomal instability (CIN), and Genomic stable (GS). (B-G) BAR expression stratified by Lei-Molecular subtypes; Proliferative (n = 70), Metabolic (n = 40), and Invasive (n = 51), from GSE15459 for (B) PXR, (C) CAR, (D) FXR, (E) GPBAR1, (F) S1PR2, and (G) CHRM2. Significance was computed by one-way ANOVA with multiple t-tests corrected for false discovery rate (FDR 1.96.Figure 3. Ingenuity pathway analysis of membrane BARs in GC. (A) Analysis of commonly upregulated disease and function pathways associated with membrane BARs. (B) Common activated and inhibited upstream regulators associated with each BAR. Dark shades indicate common associations between all three membrane BARs. Lighter hues indicate common gene associations between two membrane BARs. Red indicates predicted activity; blue indicates predicted inhibition. (C) Pathway analysis of downstream effectors common between all at least two membrane BARs. Pink (EGFR) indicates common convergence between all three BARs. All disease & function associations, pathways, and upstream regulators are significant (Z-score 1.96). Data was sourced from TCGA-FH dataset.Disclosures:Michael Rohr indicated no relevant financial relationships. Jihad Aljabban indicated no relevant financial relationships. Trina Rudeski-Rohr indicated no relevant financial relationships. Spencer Lessans indicated no relevant financial relationships. Sai Preethi Nakkina indicated no relevant financial relationships. Dexter Hadley indicated no relevant financial relationships. Deborah Altomare indicated no relevant financial relationships.

P2810 (S1343). EndoFLIP and Pyloric Dilation for Gastroparesis Symptoms Refractory to Pyloromyotomy/Pyloroplasty 1388551 Asad Jehangir Temple University Hospital EndoFLIP and Pyloric Dilation for Gastroparesis Symptoms Refractory to Pyloromyotomy/Pyloroplasty Stomach ePoster Session Award: Fellows-in-Training Award (Stomach Category)Award: Presidential Poster AwardAsad Jehangir, MD, Zubair Malik, MD, Roman Petrov, MD, PhD, Henry P. Parkman, MD, FACG; Temple University Hospital, Philadelphia, PAIntroduction: Gastroparesis (Gp) patients may undergo pyloromyotomy/pyloroplasty for chronic refractory symptoms. However, some patients have persistent symptoms. It is unknown if balloon dilation is an effective treatment strategy in these patients. We aimed to: 1) Assess if pyloric Through the Scope (TTS) balloon dilation results in symptom improvement in Gp patients with suboptimal response to pyloromyotomy/pyloroplasty; 2) Determine Endoscopic Functional Luminal Imaging Probe (EndoFLIP) characteristics of these patients before dilation.Methods: Patients with severe Gp refractory to pyloromyotomy/pyloroplasty seen from 2/2019 to 3/2020 underwent pyloric TTS dilation to 18, 19 and 20 mm after assessing the pyloric characteristics at 30-, 40-, and 50-ml EndoFLIP distension volumes. Patients completed Gastroparesis Cardinal Symptom Index (GCSI) pre-procedurally, and GCSI and Clinical Patient Grading Assessment Scale (CPGAS) on follow-ups.Results: Thirteen (10 females) patients (mean age 45.2±5.1 years) with Gp and prior pyloric surgeries (laparoscopic pyloroplasty=6, endoscopic pyloromyotomy=5, laparoscopic pyloromyotomy=1) presented with severe Gp symptoms (mean GCSI total score 3.4±0.3, Table 1). TTS dilation was performed after assessing pyloric characteristics on EndoFLIP. Overall, there was improvement of symptoms at 1-month follow-up (mean GCSI total score 3.0±0.4, p=0.04, Table 2; mean CPGAS score 1.6±0.5, p< 0.01, Table 3), with 5 patients (38%) reporting symptom improvement (4 moderately better; 1 somewhat better), and 8 with little (n=1) or no (n=7) improvement. Patients with symptom improvement reported symptoms of nausea (3), vomiting (1), and loss of appetite (1) improving the most. The patients with symptom improvement had lower pre-dilation pyloric EndoFLIP distensibility at 30 ml (4.7±0.8 vs 13.2±2.9 mm2/mmHg, p=0.04), 40 ml (7.2±1.0 vs 13.9±2.1 mm2/mmHg, p=0.02) and 50 ml (4.9±1.0 vs 10.2±1.9 mm2/mmHg, p=0.04) than patients with little/no improvement.Discussion: In Gp patients with refractory symptoms after pyloromyotomy/pyloroplasty, pyloric TTS dilation improved symptoms in about a third of the patients. Patients with symptom improvement had lower pre-dilation pyloric EndoFLIP distensibility suggesting incomplete myotomy, pyloric muscle regeneration or pyloric stricture. Pyloric EndoFLIP followed by TTS dilation seems to be a promising treatment for some patients with Gp symptoms refractory to pyloromyotomy/pyloroplasty.Disclosures:Asad Jehangir indicated no relevant financial relationships. Zubair Malik indicated no relevant financial relationships. Roman Petrov indicated no relevant financial relationships. Henry Parkman indicated no relevant financial relationships.

P2820 (S1353). Risk Factors for Gastric Cancer in a Veteran Population 1389380 Kush Fansiwala NYU Grossman School of Medicine Risk Factors for Gastric Cancer in a Veteran Population Stomach ePoster Session Kush Fansiwala, BA1, Peter S. Liang, MD, MPH2; 1NYU Grossman School of Medicine, New York, NY; 2VA New York Harbor Health System / NYU Langone Health, New York, NYIntroduction: Gastric cancer is one of the most common cancers worldwide, but evidence for screening and surveillance in the US is limited by sparse clinical research. While recent immigrants from endemic regions such as East Asia are known to be at high risk, it’s unclear what are the important risk factors in a population with fewer recent immigrants. Therefore, we conducted a matched case-control study in a VA medical center.Methods: We identified individuals with gastric cancer using both the tumor registry and electronic medical record at VA New York Harbor from 1/1/97 to 10/31/18. Diagnosis was confirmed by pathology report. Controls were identified from patients who underwent EGD during the same period. Variables of interest included age (at time of data extraction or death), sex, race/ethnicity, H. pylori status, smoking, alcohol use, pernicious anemia, and family history. Controls were matched to cases in a 2:1 ratio by age (+/- 3 years) and sex. Univariable and multivariable conditional logistic regression was performed to evaluate associations between potential risk factors and gastric cancer.Results: A total of 504 patients (168 cases and 336 controls) were identified. The mean age was 76 years and 98% were men (Table 1). Among cancer patients, 40% were diagnosed with Stage IV disease and 80% had non-cardia cancer (Table 2). On univariable analysis, associations between gastric cancer and race/ethnicity, H. pylori status, alcohol use, and pernicious anemia were observed (Table 3). On multivariable analysis, Black individuals had higher risk of gastric cancer than White individuals (OR 2.73, 95% CI 1.12-6.68). Those with H. pylori eradication had lower risk than those who were H. pylori negative (OR 0.15, 95% CI 0.06-0.38). Former alcohol users also had lower risk than never users (OR 0.26, 95% CI 0.07-0.97).Discussion: In a single-center VA study, we found Black race increased risk for gastric cancer, while H. pylori eradication and former alcohol use reduced risk. While prior US-based studies have found increased risk in East Asian and Hispanic populations, our findings suggest Black individuals are at higher risk in a healthcare system with fewer recent immigrants. Further research is required to explore this potential health disparity. That H. pylori eradication and former alcohol use were protective against gastric cancer may indicate greater adherence to medical advice and healthier lifestyles in these individuals.Table 1: Demographic and Medical CharacteristicsTable 2: Clinical Characteristics of Gastric Cancer CasesTable 3: Predictors of Gastric Cancer by Conditional Logistic RegressionDisclosures:Kush Fansiwala indicated no relevant financial relationships. Peter Liang indicated no relevant financial relationships.

P2830 (S1363). Pyloric Distensibility on FLIP Testing Predicts Clinical Response to Botox Injection Among Patients With Gastroparesis 1390015 Lester Tsai University of California San Diego Pyloric Distensibility on FLIP Testing Predicts Clinical Response to Botox Injection Among Patients With Gastroparesis Stomach ePoster Session Lester Tsai, MD, David Kunkel, MD; University of California San Diego, San Diego, CAIntroduction: Two randomized controlled trials have failed to show a benefit of endoscopic botox injection of the pylorus among patients with diabetic and idiopathic gastroparesis (GP) respectively. One possible explanation is that pyloric dysfunction is only relevant for a subset of patients with gastroparesis. Thus, we set out to examine outcomes of pyloric botox injection among patients who first underwent EndoFLIP distensibility testing of their pylorus.Methods: In this retrospective study, 29 consecutive patients who underwent EndoFLIP procedures with the EF-325N balloon through the scope (wide diameter channel endoscope) for GP were reviewed between June 2017 to August 2019. Baseline characteristics including demographics, etiology of GP, and severity of GP based on gastric retention on 4-hr scintigraphy, were recorded. Data collected from EndoFLIP procedures included the pyloric distensibility index (DI) at a balloon fill volume of 40 mL. All 200U botox injections post-EndoFLIP were tracked and considered effective if patients reported improvement lasting > 12 weeks.Results: There were 31 EndoFLIP procedures performed in 29 patients with GP. Gastroparesis was secondary to diabetes (17%), scleroderma (14%), post-surgical effects (17%) in nearly half of the patients while 52% were idiopathic in origin. The correlation between 4-hour gastric retention on scintigraphy and pyloric DI was low (R2 = .05). Among the group of patients who did not find botox injections effective, the mean pyloric DI was 9.54 with a standard deviation (SD) of 3.32. In those who found them effective, the mean pyloric DI was 13.32 with a SD of 3.47. There was a significant difference in the mean DI of patients in these two groups (p = .004).Discussion: In this study, the correlation between the amount of solid phase retention and pyloric distensibility was low. This is consistent with the understanding that gastroparesis is multifactorial in etiology and that pyloric stenosis is only relevant for a subset of these patients. Interestingly, baseline pyloric distensibility predicted treatment response. Lack of response was noted with a lower DI; whereas, a higher DI predicted a favorable clinical response. These data suggest that EndoFLIP distensibility testing of the pylorus be given important consideration in the selection of GP patients for pyloric interventions.Correlation between the amount of solid phase retention and pyloric distensibility was low in this study.Disclosures:Lester Tsai indicated no relevant financial relationships. David Kunkel indicated no relevant financial relationships.

P2840 (S1373). Relationship of Symptomatology of Gastroparesis With Gastric Emptying Studies 1390371 Waseem Amjad Albany Medical Center Relationship of Symptomatology of Gastroparesis With Gastric Emptying Studies Stomach ePoster Session Waseem Amjad, MD1, Waqas Qureshi, MD2, Yousef Nassar, MD1, Seth Richter, MD1; 1Albany Medical Center, Albany, NY; 2University of Massachusetts Medical School, Worchester, MAIntroduction: Gastroparesis is a debilitating disorder which includes several upper abdominal symptoms and documented slow gastric emptying (AJG 2013; 108:18). Past studies have shown heterogenous results of correlation between the symptoms and the gastric emptying study. We aim to study the association of symptoms with gastric emptying.Methods: We performed retrospective review of the patients diagnosed with gastroparesis between September 30th, 2009 and January 31st, 2020. The 99mTc sulfur labeled food was used to diagnose gastroparesis. The test was performed in the patients with nausea, vomiting, abdominal pain, abdominal bloating/distention, postprandial fullness/ early satiety, diarrhea, constipation and weight loss. Gastric retention of ≥ 10% of solids at 4 hours and ≥ 5% of liquids at 1 hours were identified as delayed gastric emptying. We examined relationship of presence of symptoms with the rate of gastric emptying examined by various gastric emptying test.Results: There were 320 patients (mean age 47.5±16.4 years, 70% female, 71.3% white) with gastroparesis. The prevalence of abdominal symptoms and the percentage of gastric emptying was calculated by gastric scintigraphy test. We observed that nausea, vomiting and abdominal bloating/distention were significantly associated with degree of gastric emptying (Figure 1). Patients with nausea (55.7% vs 66.6%, p=0.02) and vomiting (55.5% vs 63.7%, p=0.04) had slower liquid gastric emptying, while the solid gastric emptying rate was prolonged in individuals without abdominal distension/ bloating (71.9% vs 82.3%, p=0.004). Postprandial fullness/ early satiety, abdominal pain, constipation, diarrhea and weight loss had no significant association with the degree of gastric emptying.Discussion: In this cohort of objectively diagnosed gastroparesis, only a few symptoms correlated with delayed gastric emptying that include nausea, vomiting and abdominal distention. Symptoms alone may not be adequate to diagnose gastroparesis. Rapid gastric emptying and functional dyspepsia can also present with symptoms similar to gastroparesis, reported delayed gastric transit is important for the diagnosis of gastroparesis.Figure 1: Comparison of percentages of gastric emptying in the presence or absence of nausea, vomiting and abdominal bloating/ distention (Average percentages written above bars).Disclosures:Waseem Amjad indicated no relevant financial relationships. Waqas Qureshi indicated no relevant financial relationships. Yousef Nassar indicated no relevant financial relationships. Seth Richter indicated no relevant financial relationships.

P0140 (S1384). Acute Pancreatitis Secondary to Type B Aortic Dissection and Celiac Artery Hematoma 1388559 Reid Malcolm Geisinger Medical Center Acute Pancreatitis Secondary to Type B Aortic Dissection and Celiac Artery Hematoma Biliary/Pancreas ePoster Session Reid Malcolm, DO1, Pooja D. Patel, DO1, Ruchit N. Shah, DO2, Harshit S. Khara, MD, FACG1; 1Geisinger Medical Center, Danville, PA; 2Geisinger Commonwealth School of Medicine, Danville, PAIntroduction: Acute pancreatitis is one of the most common gastrointestinal diagnoses seen in inpatients, accounting for almost 280,000 hospital admissions annually. Cholelithiasis is the most common cause, followed by prolonged alcohol abuse. Hypertriglyceridemia, drugs, autoimmune disease, and infection each account for less than 5% of cases. Here we present a rare case of acute pancreatitis secondary to Type B aortic dissection.Case Description/Methods: A 61-year-old male presented with sudden onset right-sided and periumbilical abdominal pain with radiation to the epigastrium and mild chest pain. He had no pertinent medical history and no significant alcohol use history. On presentation, he was hypertensive and tachypneic. Physical examination revealed a diaphoretic male with diffuse abdominal tenderness. Laboratory work up showed a leukocytosis of 17.24 K/uL, lactate 4mmol/L, LDH 374 U/L, and lipase 383 U/L. CT angiography showed a prominent Stanford Type B aortic dissection with an intramural hematoma extending along the descending thoracic aorta through the upper abdominal aorta leading to occlusion of the celiac artery. His dissection was treated with esmolol drip with rapid correction of blood pressure to goal systolic blood pressure 100-120. Due to persistent leukocytosis, on hospital day 3 repeat CT imaging was performed revealing increasing irregular fluid scattered throughout the upper abdomen consistent with acute pancreatitis. Alternative etiologies were ruled out and this pancreatitis was presumed to be caused by vascular compromise in the setting of a type B aortic dissection and celiac artery hematoma. He showed gradual clinical improvement with medical management and was discharged home.Discussion: Blood supply to the pancreas is provided by pancreatic branches of the splenic artery (from the celiac artery), and the superior and inferior pancreaticoduodenal arteries (from the superior mesenteric artery). The mechanism of pancreatitis caused by type B aortic dissection is organ ischemia, through occlusion of either the celiac artery or the superior mesenteric artery SMA. Most type B aortic dissections are managed conservatively with antihypertensives, but end organ ischemia can be an indication for surgical management. This presentation is exceedingly rare; we note only 6 similar cases in the literature. As our case demonstrates, acute pancreatitis as a complication of aortic dissection can be managed with standard conservative measures and does not necessitate surgical intervention.Computed tomography angiogram shows a Stanford Type B Aortic Dissection (2 views).Chest computed tomography imaging shows irregular fluid scattered throughout the upper abdomen representative of acute pancreatitis.Computed tomography angiography reveals mild interval increase in peripancreatic fluid collections.Disclosures:Reid Malcolm indicated no relevant financial relationships. Pooja Patel indicated no relevant financial relationships. Ruchit Shah indicated no relevant financial relationships. Harshit Khara: Boston Scientific – Consultant, Speaker's Bureau. ConMed – Consultant, Speaker's Bureau. Medtronic – Consultant, Speaker's Bureau. Olympus America – Consultant, Speaker's Bureau. Pentax – Consultant, Grant/Research Support, Speaker's Bureau.

P0150 (S1394). A Rare Form of Secondary Sclerosing Cholangitis Seen in Critically Ill Patients 1388791 Brianna Shinn Thomas Jefferson University Hospital A Rare Form of Secondary Sclerosing Cholangitis Seen in Critically Ill Patients Biliary/Pancreas ePoster Session Brianna Shinn, MD, David Loren, MD; Thomas Jefferson University Hospital, Philadelphia, PAIntroduction: Secondary sclerosing cholangitis (SSC) is caused by biliary obstruction and damage to the biliary tree often with progression to cirrhosis. There is a rare entity of SSC following resolution of critical illness without preexisting biliary obstruction called “secondary sclerosing cholangitis in critically ill patients” (SSC-CIP). We present a case of SSC-CIP in a patient with respiratory failure from influenza A.Case Description/Methods: A 44-year-old man with no preexisting hepatobiliary disease developed respiratory failure requiring intubation secondary to Influenza A. He required pronation as well as veno-venous extracorporeal membrane oxygenation (VV-ECMO). Two months after his respiratory failure resolved he was discharged. Shortly thereafter he returned with sepsis manifest as fever, leukocytosis and an elevated alkaline phosphatase to 1323 IU/L. MRCP demonstrated multifocal hepatic abscesses and irregular appearing right intrahepatic bile ducts with strong enhancement, suspicious for cholangitis (Figure 1). ERCP revealed irregularity and saccular dilation of the right intrahepatic ducts with viscous bile, brown stones, and debris. The extrahepatic common bile duct appeared normal. The endoscopic findings in this clinical context were consistent with SSC-CIP.Discussion: While secondary sclerosing cholangitis most commonly presents with biliary obstruction, SSC-CIP has a unique presentation with hepatic abscesses in the absence of biliary obstruction following resolution of critical illness. Although rare, the majority of cases in the literature develop in patients recently recovered from ARDS secondary to influenza A. Although the pathophysiology underlying SSC-CIP has not been definitively elucidated, it has been postulated that biliary ischemia of the intrahepatic bile ducts supplied by the hepatosplanchnic plexus is the dominant cause of disease development. Given its novelty, it has been suggested that newer therapies in critical care medicine may contribute to SSC-CIP, specifically both lung protective mechanical ventilation for ARDS which includes high PEEP and low tidal volumes as well as prone positioning. These interventions increase intra-abdominal pressure and can lead to decreased hepatosplanchnic blood flow and subsequent biliary ischemia. With the advent of COVID19 we expect to see more patients affected by this entity, and patient care will be enhanced by physician awareness of SSC-CIP.MRCP showing multifocal intrahepatic biliary ductal dilatation with diffuse irregularity.Disclosures:Brianna Shinn indicated no relevant financial relationships. David Loren: Boston Scientific – Consultant. Olympus America – Consultant.

P0160 (S1404). Duodenal Perforation After Biliary Stent Placement: How Early Should We Expect It? A Case Report 1388461 Fidelis Okoli Maimonides Medical Center Duodenal Perforation After Biliary Stent Placement: How Early Should We Expect It? A Case Report Biliary/Pancreas ePoster Session Fidelis C. Okoli, MBBS, Shmuel Golfeyz, MD, Daniel J. Waintraub, MD, Mohammad Hamshow, MD, Kadirawel Iswara, MD, FACG; Maimonides Medical Center, Brooklyn, NYIntroduction: Endoscopic placement of biliary stents is commonly performed to reestablish bile flow. Stent migration with intestinal perforation is a rare life-threatening complication. We report a case of a biliary stent causing an early duodenal perforation that was diagnosed laparoscopically four days after stent placement.Case Description/Methods: A 23-year-old woman presented with two days of worsening RUQ abdominal pain with associated dark urine and pale stool. On physical examination, she appeared ill and uncomfortable with scleral icterus and mild epigastric tenderness. Laboratory evaluation demonstrated a total bilirubin of 4.5mg/dL, direct bilirubin of 2.8mg/dL, ALT 354mg/dL, AST 174mg/dL, ALP 118mg/dL , CA 19-9 143U/ml and normal hepatitis serologies. MRCP showed beading of the intrahepatic biliary tree with high grade strictures of the right and left hepatic ducts, suggesting Primary Sclerosing Cholangitis; cholelithiasis, choledocholithiasis with mild dilatation of the CBD and the intrahepatic biliary ducts [figure 1]. ERCP with sphincterotomy and stone extraction as well as brushings from the strictured portions was performed. A 7Fr x 9cm and a 7Fr x 15cm straight plastic stents were placed in the right and left intrahepatic ducts respectively [figure 2]. The evening after the procedure, she developed vomiting and abdominal pain together with elevated lipase and leukocytosis; findings attributable to post-ERCP pancreatitis. The next morning, she developed RLQ pain. She was scheduled to undergo laparoscopic cholecystectomy, so an exploration of the right lower quadrant was also planned. Laparoscopy reveled the biliary stent eroding through the duodenum causing a perforation [figure 3]. There was also significant bilious fluid leakage into the right paracolic gutter associated with inflammation. She underwent repair of the duodenal perforation and had a right hemicolectomy with ileocolic anastomosis. She did well post-op.Discussion: Stent migration is a common complication and measures, such as creation of internal flanges and pigtails, have been taken to mitigate this. Consideration of indication, condition, size and other risk factors is important when assessing what type of stent to use. With the increased use of biliary stents, it is important for physicians to be aware of the many different complications that may arise. Although there are some well-established common complications, an astute physician will consider atypical presentations as cause for concern and further evaluation.Figure 1 show beading of the intrahepatic biliary tree with high grade strictures of the right and left hepatic ductsFigure 2: 7Fr x 9cm straight plastic stent in the right intrahepatic system and a 7Fr x 15cm straight plastic stent in the left intrahepatic systemFigure 3: Stent eroding through the duodenumDisclosures:Fidelis Okoli indicated no relevant financial relationships. Shmuel Golfeyz indicated no relevant financial relationships. Daniel Waintraub indicated no relevant financial relationships. Mohammad Hamshow indicated no relevant financial relationships. Kadirawel Iswara: Abbvie – Consultant, Speaker's Bureau. Gilead – Consultant, Speaker's Bureau. Pfizer – Consultant, Speaker's Bureau.

P0170 (S1414). Successful Endoscopic Management of Necrotizing Pancreatitis Due to Rare Anatomical Variants 1389618 Michelle Baliss University of Texas Medical Branch Successful Endoscopic Management of Necrotizing Pancreatitis Due to Rare Anatomical Variants Biliary/Pancreas ePoster Session Michelle Baliss, DO1, Christopher Nguyen, DO1, Thomas Houghton, DO1, Sruti Rachapudi, MS1, Sreeram Parupudi, MD1, Kelly Olino, MD2; 1University of Texas Medical Branch, Galveston, TX; 2Yale New Haven Hospital, Guilford, CTIntroduction: Pancreatic divisum (PD) is an embryological failure of fusion of the ventral and dorsal pancreatic ducts. Meandering main pancreatic duct (MMPD) is another rare developmental loop-type anomaly in the main duct. PD and MMPD are more prevalent in idiopathic recurrent acute pancreatitis (IRAP). We report a case of recurrent necrotizing pancreatitis in a patient with these anatomical variants, fascinatingly resulting in complete resolution after staged direct endoscopic necrosectomies.Case Description/Methods: A 51-year-old male presented with epigastric pain and vomiting. Physical examination, complete blood count, complete metabolic panel, lipase and lactic acid were unremarkable. Abdominal CT showed acute pancreatitis with 10% parenchymal necrosis and 7x8x15 cm peripancreatic walled-off necrosis. He was managed with fluids, pain and anti-emetics and tolerated diet advancement. The etiology of his pancreatitis was unclear given absence of alcohol abuse and biliary pathology and negative autoimmune work-up. He was discharged with plans to repeat imaging 6 weeks later at which time he was readmitted for fevers and pain recurrence. Abdominal CT showed increase in size of the walled-off necrosis to 15x10x20 cm (Fig1). He was treated with antibiotics and underwent endoscopic cystogastrostomy. His clinical course was complicated by splenic vein and upper extremity deep venous thrombi and a pulmonary embolism requiring anticoagulation. While on anticoagulation, he underwent 14 careful staged endoscopic necrosectomies over two months until complete resolution (Fig2). Subsequent ERCP demonstrated incomplete PD and reverse-Z MMPD (Fig3). A stent was placed into the ventral pancreatic duct and he was managed with pancreatic enzyme replacement, remaining asymptomatic on 1-year follow-up.Discussion: PD and MMPD are rare embryological errors, carrying ~40% prevalence in cases of IRAP and are thought to play a role in disease onset. Necrosis complicates 20% of acute pancreatitis cases with a 25% mortality rate. While two thirds of cases resolve with conservative measures, the remainder require intervention with endoscopic necrosectomy to avoid open surgical approaches with high mortality. Large multi-center studies have demonstrated successful resolution with endoscopic necrosectomy in ~90% of cases with significantly lower mortality. This case serves to illustrate the effectiveness of endoscopic necrosectomy even in the face of anticoagulation and to prompt physicians to consider PD and MMPD in IRAP.Figure 1: CT showing necrotic collectionFigure 2: Endoscopic necrosectomyFigure 3: ERCP showing PD and MMPD anatomical variantsDisclosures:Michelle Baliss indicated no relevant financial relationships. Christopher Nguyen indicated no relevant financial relationships. Thomas Houghton indicated no relevant financial relationships. Sruti Rachapudi indicated no relevant financial relationships. Sreeram Parupudi indicated no relevant financial relationships. Kelly Olino indicated no relevant financial relationships.

P0180 (S1424). Sarcoidosis of the Extrahepatic Bile Duct 1389270 Muhammad Alsayid Rush University Medical Center Sarcoidosis of the Extrahepatic Bile Duct Biliary/Pancreas ePoster Session Muhammad Alsayid, MD, MPH, Anas Alabkaa, MD, Ajaypal Singh, MD; Rush University Medical Center, Chicago, ILIntroduction: Hepatic manifestations occur in 12.8% of patients with sarcoidosis. Enlarged lymph nodes in the porta hepatis may cause bile duct obstruction and strictures. However, extrahepatic biliary strictures due to primary involvement of the bile duct is extremely rare. We present a patient with extrahepatic biliary obstruction due to sarcoidosis.Case Description/Methods: A 56-year-old African American woman presented to the ER with a 2-day history of nausea and painless jaundice. Vital signs were within normal limits and physical exam revealed icteric sclera. Laboratory showed total bilirubin of 8.4 mg/dL, conjugated bilirubin 7.5 mg/dL, alkaline phosphatase 606 IU/L, AST 107 IU/L, ALT 189 IU/L, and lipase 132 U/L. CT abdomen/pelvis with IV contrast showed moderate central intrahepatic biliary ductal dilatation with compression of the bile duct confluence secondary to enlarged lymph nodes at the porta hepatis. CA 19-9 and AFP were normal. EUS revealed intrahepatic biliary duct dilation and multiple enlarged lymph nodes in the porta hepatis. FNA/FNB were performed. ERCP showed a single severe stricture in the hepatic biliary duct bifurcation 20 mm in length. Sphincterotomy was performed and a plastic stent was placed in the dilated left system. Biopsy results showed reactive multi-nucleated giant cells without malignancy. A repeat EUS and ERCP were performed within 6 weeks and biopsies from lymph nodes showed sarcoid-like granulomas without malignancy. The patient was started on prednisone 30 mg daily for sarcoidosis once her liver enzymes were normalized. She underwent ERCP with cholangioscopy, which showed irregular and nodular mucosa of the bile duct and it was biopsied. Biopsy results showed epithelioid histiocytes forming non-caseating granulomas. Subsequently, the patient underwent multiple ERCP procedures with plastic stents exchanges along with steroids and other immunomodulators to treat the biliary stricture. Nonetheless, the bile duct stricture did not respond to treatment so hepatojejunostomy is being considered. Discussion: Extrahepatic biliary obstruction that is caused by enlarged lymph nodes in the porta hepatis improves with steroids due to the reduction is size of lymph nodes. Our patient had an improvement in the size of lymph nodes in response to steroids, however she continued to have a biliary stricture due to primary involvement of the bile duct. Therefore, hepatojejunostomy is being considered as a curative option.ERCP - Biliary strictureCholangioscopy - Biliary stenosisBile duct core biopsy showing epithelioid histiocytes forming non-caseating granulomas (arrows)Disclosures:Muhammad Alsayid indicated no relevant financial relationships. Anas Alabkaa indicated no relevant financial relationships. Ajaypal Singh indicated no relevant financial relationships.

P0190 (S1434). Hemosuccus Pancreaticus From the Minor Papilla 1390285 Benjamin Fiore Naval Medical Center Hemosuccus Pancreaticus From the Minor Papilla Biliary/Pancreas ePoster Session Benjamin Fiore, MD1, Thomas E. Mellor, DO1, Nanae Takatori, MD2; 1Naval Medical Center, San Diego, CA; 2Sharp Rees Stealy Medical Group, San Diego, CAIntroduction: Hemosuccus Pancreaticus (HP), typically defined as bleeding from the major papilla, is an exceedingly rare cause of gastrointestinal bleeding. Even rarer, is the subset due to bleeding from the minor papilla via the duct of Santorini, with data limited to few case reports. We present a case of HP with bleeding from the minor papilla secondary to rupture of a gastroduodenal artery (GDA) branch pseudoaneurysm into a pancreatic pseudocyst from a previous episode of gallstone pancreatitis.Case Description/Methods: A 63-year-old female with history of end stage renal disease on hemodialysis, coronary artery disease status post recent drug eluting stent on dual antiplatelet therapy, and remote history of gallstone pancreatitis with known pseudocysts presented with 1 day of nonspecific abdominal pain and 4 episodes of small volume black stool. Exam revealed normal vital signs, benign abdomen, and black stool in the rectal vault. Labs notable for hemoglobin 7.6g/dL (baseline 8.5), and elevated lipase to 282 unit/L [13-60]. Endoscopy with side viewing scope revealed bile from the major papilla and frank bleeding from the minor papilla. CT angiogram demonstrated a lobulated pancreatic head, with multiple cysts and 1cm enhancing nodule concerning for a pseudoaneurysm or islet cell tumor. IR angiography identified the blood supply of the nodule as a branch of the GDA with visible blush treated successfully with coil embolization. MRI of the abdomen showed fullness of the pancreatic head without a discrete mass or evidence of pancreas divisum. Endoscopic ultrasound was recommended, but patient declined. Overall, her presentation was consistent with ruptured pseudoaneurysm into a pseudocyst causing HP from the minor papilla.Discussion: HP occurs from an abnormal communication between the pancreatic duct and a vascular structure. Pancreatitis (acute or chronic) is the most common cause of HP; others include arterial aneurysm, pancreatic tumors, iatrogenic, trauma, and pseudoaneurysm of the GDA seen in 20-25% of cases. Endoscopic visualization of bleeding from the papilla is diagnostic but occurs in only 30% of cases. CT is utilized to identify etiology and infrequently reveals a sentinel clot in the pancreatic duct. IR is the gold standard for therapy with immediate success rates of 79-100% and surgery reserved for hemodynamic instability. Effective therapy is crucial; left untreated, the mortality rate is as high as 90%.Side-viewing gastroduodenoscopy of the minor duodenal papilla with frank blood (left) and major duodenal papilla with bile (right).CT angiography of the abdomen and pelvis with IV contrast demonstrating arterial enhancing pancreatic head nodule (arrow).IR angiography of gastroduodenal artery branch pre (left) and post (right) successful coil embolization.Disclosures:Benjamin Fiore indicated no relevant financial relationships. Thomas Mellor indicated no relevant financial relationships. Nanae Takatori indicated no relevant financial relationships.

P0200 (S1444). Triglyceride-Induced Pancreatitis Secondary to Suspected Hemophagocytic Lymphohistiocytosis 1390380 Taha Mohamed Djirdeh Mercy Health System Triglyceride-Induced Pancreatitis Secondary to Suspected Hemophagocytic Lymphohistiocytosis Biliary/Pancreas ePoster Session Taha Mohamed Djirdeh, MD1, Nicole Gentile, MD2, Altaf Dawood, MBBS, MD2, Mario Affinati, MD3; 1Mercy Health System, Rockford, IL; 2Mercyhealth, Rockford, IL; 3Merchyhealth Rockford, Rockford, ILIntroduction: HIV is commonly associated with multiple complications. However, we present a patient with newly diagnosed HIV, pancreatitis, and concern for acute liver failure secondary to a rare phenomenon.Case Description/Methods: A 36 year old male with no PMH presented with poor appetite, malaise, and fatigue. He was diagnosed with HIV with CD4 count of 12 and a viral load of 1.3 million copies, started on HAART therapy and discharged.He was readmitted a few weeks later with generalized weakness, nausea, and jaundice. Labs demonstrated renal failure with creatinine of 12.2 (baseline 1.5) and potassium 8.4 for which he had urgent hemodialysis. In addition, his alkaline phosphatase was 228, ALT 135, AST 213, and total bilirubin of 12.4. INR was 2.1. Lipase was 252, triglycerides 1388, CD4 count 9. On admission, hemoglobin was 9.7gm/dL, platelet count 177X(10)3/uL and dropped to 6.1 gm/dL and 94 X(10)3/uL in the next couple days. Fibrinogen was 214mg/dL, ferritin level was 11,170. Therefore, bone marrow aspirate analysis was performed and showed hemophagocytosis of two RBC, a second histiocyte showed hemophagocytosis of 3 RBC, one of which was indenting the nucleus with 3 pyknotic cell nuclei in the cytoplasm of the histiocyte. With high concern for Hemophagocytic Lymphohistiocytosis (HLH), patient was transferred to a higher level of care for consideration of etoposide based treatment.This is an atypical presentation of HLH based on lack of fever and splenomegaly. HLH is a rare disease that may be diagnosed via molecular diagnosis or by clinically meeting 5 of 8 criteria including fever, splenomegaly, cytopenias, hypertriglyceridemia and/or hypofibrinogenemis, hemophagocytosis in bone marrow or spleen or lymph nodes, no malignancy, ferritin ≥500 µg/L, and soluble CD25 (i.e., soluble IL‐2 receptor) ≥2,400 U/ml.HLH is a syndrome of severe hyperinflammation secondary to abnormally activated macrophages and cytotoxic T cells. There is a genetic form and an aquired form triggered by infection or malignancy. HLH pathogenesis is secondary to excessive cytokine activity in the vascular system.Discussion: Overall HLH is associated with a poor prognosis with over 10% of patients with this condition dying in the span of 2 months secondary to DIC, neutropenia or multi-organ failure. The main treatment is to treat the underlying cause. In conclusion, we present a rare presentation of newly diagnosed HIV resulting in ALF and HLH demonstrating the importance of prompt disease recognition due to poor outcomes.Disclosures:Taha Mohamed Djirdeh indicated no relevant financial relationships. Nicole Gentile indicated no relevant financial relationships. Altaf Dawood indicated no relevant financial relationships. Mario Affinati indicated no relevant financial relationships.

P0210 (S1454). Severe Acute Pancreatitis Initial Presentation of COVID-19 Infection 1389722 David Truscello Rowan University School of Osteopathic Medicine Severe Acute Pancreatitis Initial Presentation of COVID-19 Infection Biliary/Pancreas ePoster Session David J. Truscello, DO1, Maulik Shah, DO1, Faris M. Murad, MD2; 1Rowan University School of Osteopathic Medicine, Stratford, NJ; 2GI Partners of Illinois LLC, Libertyville, ILIntroduction: SARS-CoV-2, also known as the COVID-19 has affected more than 7 million people worldwide. While the most common initial symptoms are cough and fever, it is known that approximately 50% of patients present with GI related symptoms. We discuss below a case of a COVID-19 patient who initially presented with unexplained severe acute pancreatitis (AP).Case Description/Methods: A 71-year-old male presented to the hospital with significant abdominal pain for one day. In the ER, a contrast enhanced CT scan showed peripancreatic inflammation and peripancreatic fluid along the body and tail. The initial lipase was 8400 u/L (73-393 u/L). The patient had no alcohol history or evidence of biliary obstruction. He denied acetaminophen, steroids, or any new medications. The lipid panel was normal along with the LFTs. The BISAP score on admission was 3 for: age > 60, BUN > 25, and SIRS criteria of fever and leukocytosis. He was treated for severe acute pancreatitis with aggressive IV fluid hydration. On day 4, he had resolution of his abdominal pain and was tolerating a full liquid diet. Despite improvement in his severe acute pancreatitis, the patient developed persistent fevers and increasing oxygenation requirements. A chest X-Ray was then performed with showed infiltrates concerning for pneumonia. He tested positive for COVID-19 and then developed progressive deterioration toward acute hypoxemic respiratory failure. He was transferred to the ICU and intubated on day 19 of his stay and expired a short time after.Discussion: An extensive literature has revealed few cases involving COVID-19 induced AP. While many theories behind this disease process have been discussed, there is no definitive explanation for the pathogenesis. There has been evidence showing ACE2 receptor expression on the pancreas is responsible for damage during a COVID-19 infection. One such study out of China showed 1-2% of non-severe COVID patients and 17% of severe COVID patients exhibited some degree of pancreatic damage. Endothelial damage from the patient’s inflammatory response can cause activation of the cytokine cascade. Too much IL-6 activation, as seen with COVID-19, can cause a cytokine storm leading to pancreatitis. While certain viral illnesses have a well-established link to AP, more research needs to be undertaken to determine whether a true relationship exists with the coronavirus. This case highlights that during this global pandemic, unexplained acute pancreatitis may be a presenting symptom of COVID-19 infection.Disclosures:David Truscello indicated no relevant financial relationships. Maulik Shah indicated no relevant financial relationships. Faris Murad indicated no relevant financial relationships.

P0220 (S1464). Acute Cholangitis Secondary to Surgical Clip Migration After Laparoscopic Cholecystectomy 1390632 Sarav Gunjit Singh Daid Roger Williams Medical Center Acute Cholangitis Secondary to Surgical Clip Migration After Laparoscopic Cholecystectomy Biliary/Pancreas ePoster Session Award: Presidential Poster AwardSarav Gunjit Singh Daid, MD1, Eddie Copelin, MD2, Amer Malik, MD1; 1Roger Williams Medical Center, Providence, RI; 2Winthrop University Hospital, Mineola, NYIntroduction: Acute Cholangitis from common bile duct obstruction is an indication for emergent ERCP. Surgical clip migration into the common bile duct as the etiology of acute cholangitis is a rare phenomenon in laparoscopic cholecystectomy that is not entirely understood. To our knowledge, surgical clip migration causing acute cholangitis is a documented but rare complication with few published cases to date.Case Description/Methods: A 54-year-old female with a history of asthma, gastroesophageal reflux disease, diverticulitis, pancreatitis, and laparoscopic cholecystectomy three years ago presented with a 2-day history of epigastric right upper quadrant pain. The patient had a fever of 101.3F; her liver function tests were abnormal, and an abdominal CAT scan showed a linear high-density object in the distal common bile duct most likely felt to be a surgical clip. Next, an MRCP showed the question of a migrated surgical clip to the distal common bile duct. Subsequent ERCP was inconclusive. However, follow up X-ray (KUB) afterward showed the clip in the RUQ suggesting that the clip may have passed further down the bowel duct and it was decided to do ERCP with spyglass for better visualization.The initial view during ERCP with the spyglass did not reveal the metal clip. The metal clip was then visualized on fluoroscopy after the withdrawal of the endoscope. A conventional biopsy forceps retrieved the metal clip from the bile duct. The patient tolerated the procedure well with no complications. Her LFTs trended down abdominal pain resolved. Pt was discharged the next day with a one week follow up that resulted in a benign physical exam and LFTsDiscussion: Acute Cholangitis from a surgical clip is a rare complication of laparoscopic cholecystectomy. The exact mechanism behind the migration of the surgical clip is not well understood. However, the hypothesis that has been stated is that increased pressure applied to the clipped collecting duct by the liver promotes necrosis allowing the clips to then invagination and fall into the common bile duct, thus serving a nidus for gallstone formation. The range of presentations may be from 11 days to 20 years with a median of 26 months. The most common diagnosis at presentation is obstructive jaundice (37.7%) followed by cholangitis (27.5%) with biliary colic. Acute cholangitis secondary to clip migration after laparoscopic cholecystectomy should be recognized early with accurate imaging and treated with ERCP and stone extraction.Retrograde catheterization of the common bile duct demonstrates an adjacent malpositioned, migrated surgical clip (arrow) and a wire extending into  the hepatic duct above the clip.Status Post Surgical Clip RemovalDisclosures:Sarav Gunjit Singh Daid indicated no relevant financial relationships. Eddie Copelin indicated no relevant financial relationships. Amer Malik indicated no relevant financial relationships.

P0230 (S1474). Acute Pancreatitis as an Early Complication of Laparoscopic Sleeve Gastrectomy 1387841 Seetha Lakshmanan Roger Williams Medical Center Acute Pancreatitis as an Early Complication of Laparoscopic Sleeve Gastrectomy Biliary/Pancreas ePoster Session Seetha Lakshmanan, MD, Amer Malik, MD; Roger Williams Medical Center, Providence, RIIntroduction: Bariatric surgery remains a safe and effective long term solution to help curb the growing obesity problem worldwide. Laparoscopic sleeve gastrectomy (LSG) is the most common surgical intervention performed. Acute pancreatitis (AP) is a rarely reported complication. Herein we present a case of AP within 30 days of LSG.Case Description/Methods: A 27-year-old morbidly obese female underwent LSG and paraesophageal hiatal hernia repair after complete outpatient evaluation. On post-op day (POD) 2, she was discharged home upon tolerating a liquid diet. She presented to the Emergency Department (ED) four days later with multiple episodes of diarrhea and lethargy. Stool studies did not reveal any infection. She was hydrated and discharged home. On POD 16, she returned with nausea and inability to tolerate solid food but denied any abdominal pain. Her lipase was elevated at 511U/L. However, CT Abdomen with contrast was normal. She was advised to stay hydrated and discharged with antiemetics. She was re-evaluated twice more for similar complaints and on her 5th ED visit on POD 26, she was admitted for severe nausea and poor oral intake. Patient still denied abdominal pain but endorsed some regurgitation. She appeared dehydrated and her abdominal exam was benign. Labs revealed WBC 12000/µL, Creatinine 0.8mg/dL, normal bilirubin/liver enzymes, and Lipase 687U/L. Repeat CT Abdomen showed inflammation of the posterior pancreas and a normal gallbladder. Esophagogastroduodenoscopy revealed Hill Grade III gastroesophageal flap valve and gastritis at the junction of the gastric body and antrum without stricture or leak. Patient was aggressively hydrated the first day and subsequently started on total parenteral nutrition. Her lipase peaked at 785U/L but she clinically improved and was discharged home 3 days later. She did well on follow-up without any sequelae.Discussion: AP is an under-recognized complication associated with any bariatric surgery. In a retrospective study by Hussan et al, they reported a 2-fold increase in AP risk within 6 months after LSG when compared to other bariatric surgeries. There are many hypotheses for this potentially life-threatening complication including gallstones, postprandial peak of cholecystokinin promoting the release of pancreatic enzymes, peripancreatic tissue adhesion intraoperatively, or compromised pancreatic microcirculation. As the number of LSG performed annually continues to increase, a high index of suspicion should remain for AP as a potential early complication.Disclosures:Seetha Lakshmanan indicated no relevant financial relationships. Amer Malik indicated no relevant financial relationships.

P0240 (S1484). Masquerading Masses 1389027 Vikram Patel Cooper University Hospital Masquerading Masses Biliary/Pancreas ePoster Session Vikram Patel, MD1, Upasana Joneja, MD1, Adib Chaaya, MD1, Meet Parikh, DO2; 1Cooper University Hospital, Camden, NJ; 2Cooper University Hospital, Paramus, NJIntroduction: Amongst isolated solid pancreatic masses identified radiologically in middle aged adults, common diagnoses rendered on histology include adenocarcinoma and neuroendocrine tumors. Ninety percent of all pancreatic solid masses are pancreatic adenocarcinomas which carry a grim prognosis. Herein, we present two cases of isolated solid pancreatic masses radiologically masquerading as carcinomas that highlight the importance of clinico-pathologic correlation in directing management of patients with pancreatic lesions.Case Description/Methods: Case 1 is of a 51-year-old male with benign prostatic hyperplasia who presented to his urologist for recurrent urinary tract infection. Computed tomography (CT) was performed and showed a 9.5 x 4.9 cm mass in the pancreatic body and tail concerning for adenocarcinoma. Magnetic resonance image (MRI) showed enhancing rind of soft tissue in the body and tail without peripancreatic vascular attenuation (Figure 1a) and endoscopic ultrasound (EUS) showed diffuse heterogeneous echogenicity suggestive of autoimmune pancreatitis. IgG4 serum levels were within normal range. Fine needle aspiration (FNA) of the mass showed a CD10+ B-cell lymphoproliferative disorder and final pathologic diagnosis of low-grade follicular lymphoma was rendered (Figure 2a). The patient is currently on chemotherapy and responding favorably.Case 2 is of a 70-year-old male who presented with abdominal discomfort. A CT abdomen and pelvis revealed a well-delineated 1.9 x 1.5cm distal pancreatic tail mass. MRI showed that the lesion was isointense to the spleen and pancreas with prominent solid arterial phase enhancement and moderate diffusion restriction suggestive of a neuroendocrine tumor. PET NETSPOT scan also supported a somatostatin receptor avid tumor. An EUS with FNA demonstrated benign splenic tissue consistent with the diagnosis of intrapancreatic accessory spleen (Figure 2b).Discussion: Increased use of imaging has led to a growing number of identified pancreatic abnormalities. While ductal adenocarcinoma of the pancreas is commonly encountered in the presence of isolated solid pancreatic masses, rare malignant entities such as lymphoma and non-malignant entities such as intrapancreatic accessory spleen should remain on the differential diagnosis. These cases illustrate that despite characteristic radiologic findings, tissue diagnosis is prudent prior to management of any pancreatic lesion as consequences of erroneous therapy can be dire. Figure 1a. MRI abdomen showing normal diameter pancreatic duct with thickening of pancreatic tail and encasement of splenic vein.Figure 2a. Pancreatic body/tail mass biopsy showing small atypical lymphocytic infiltrate surrounding pancreatic parenchyma, immunophenotypically consistent with low grade follicular lymphoma.Figure 2b. Pancreatic tail mass fine needle aspiration showing benign splenic tissue. CD8 highlights splenic sinusoidal cells in the secondary image.Disclosures:Vikram Patel indicated no relevant financial relationships. Upasana Joneja indicated no relevant financial relationships. Adib Chaaya indicated no relevant financial relationships. Meet Parikh indicated no relevant financial relationships.

P0250 (S1494). Gastroduodenal Artery Pseudoaneurysm in the Setting of Necrotizing Pancreatitis 1387820 Nisa Desai University of Virginia Health System Gastroduodenal Artery Pseudoaneurysm in the Setting of Necrotizing Pancreatitis Biliary/Pancreas ePoster Session Nisa Desai, MD1, Brian Peterson, MD2, Vanessa Shami, MD2; 1University of Virginia Health System, Charlottesville, VA; 2University of Virginia, Charlottesville, VAIntroduction: Gastroduodenal artery (GDA) pseudoaneurysms are a rare but fatal condition, representing about 1.5% of all visceral artery aneurysms.. If ruptured, mortality rate is high as 75%, particularly from severe upper gastrointestinal bleeding. Fortunately, the availability of imaging studies allows for early detection of these vascular events. Historically, they used to be treated either through surgical ligation or resection. Currently, minimally invasive endovascular procedures can be performed, resulting in a significant reduction in morbimortality.Case Description/Methods: 41 year old female with a history of Roux en Y gastric bypass, pancreatic divisum, chronic pancreatitis complicated by necrotic fluid collections was admitted for severe protein calorie malnutrition. She had a G tube place that persistently leaked, requiring a J arm for nutrition. Her hospital course was further complicated by peritonitis and serratia bacteremia, for which she received intravenous antibiotics. Six days after placement of her J arm, she began to have worsening epigastric pain. She became tachycardic up to the 140s. Abdominal exam was soft with epigastric tenderness without rebound or guarding. Labs were notable for new leukocytosis to 23 and a hemoglobin reduction from 8 to 6.6. CT imaging showed gastrostomy tube migration outside the stomach remnant, with spillage of gastric contents in the peritoneum. In addition to the known complicated necrotizing pancreatitis, the scan revealed a new development of a GDA pseudoaneurysm, 2 cm in size. Surgery was consulted to reposition the gastrostomy tube. Interventional radiology was also consulted for urgent GDA pseudoaneurysm coiling. Patient’s hemoglobin stabilized to her baseline the following days.Discussion: Hemorrhagic complications of pancreatitis are rarely seen. Typically, patients with GDA pseudoaneurysms are asymptomatic or have non-specific abdominal pain. If ruptured, mortality rate is high as 75%. Fortunately, the availability of imaging studies allows for early detection of these vascular events. Gold standard diagnostic test is visceral angiography which provides both diagnostic and therapeutic value and has a 100% sensitivity. CT imaging is noninvasive and has a 67% sensitivity. Historically, they used to be treated either through surgical ligation or resection. We now are able to perform minimally invasive endovascular procedures, resulting in a significant reduction in morbimortality.Gastroduodenal artery pseudoaneurysm (red arrow), 2cm in size, with surrounding complicated necrotizing pancreatitisTranscatheter selective embolization via coiling of the gastroduodenal artery pseudoaneurysmDisclosures:Nisa Desai indicated no relevant financial relationships. Brian Peterson indicated no relevant financial relationships. Vanessa Shami indicated no relevant financial relationships.

P0260 (S1504). Large Cell Neuroendocrine Carcinoma of the Gallbladder - Where Survival Is a Rare Entity! 1388987 Samyak Dhruv Staten Island University Hospital Large Cell Neuroendocrine Carcinoma of the Gallbladder - Where Survival Is a Rare Entity! Biliary/Pancreas ePoster Session Samyak Dhruv, MD1, Dhineshreddy Gurala, MD2, Abhishek Polavarapu, MD3, Anupma Agarwal, MD1, Jocelyn D. Villanueva, MD1, Stephen Mulrooney, MD3; 1Staten Island University Hospital, New York, NY; 2Staten Island University Hospital, Northwell Health, Staten Island, NY; 3Staten Island University Hospital, Staten Island, NYIntroduction: Neuroendocrine neoplasm (NEN) is a rare heterogenous neoplasm that originates from the neuroendocrine cells with the incidence of 5.25 per 100,000 people. These tumors are frequently found in the gastrointestinal (GI) tract followed by bronchopulmonary system. In the GI tract appendix, jejunum, ileum and rectum are most frequently involved. Gallbladder NEN is very rare contributing to 0.5% of all NEN and 2.1% of gallbladder cancers, with highest incidence in sixth and seventh decade. NEN are classified into well differentiated neuroendocrine tumor (NET) and poorly differentiated neuroendocrine cancer (NEC). NEC is divided based on histopathology into small cell and large cell NEC (#Figure 1). Large cell NEC is exceedingly rare aggressive tumor with worse prognosis. Herein we report a rare case of Large cell gall bladder NEC with extensive hepatic involvement in a patient presented with constipation.Case Description/Methods: A 72-year-old male presented to emergency department with constipation for last three months. Vital signs were stable. On physical examination abdomen was distended and non-tender. Computed tomography (CT) of the abdomen demonstrated ill-defined 7.2X4.9 cm hypodense lesion in the gall bladder fossa with extension into the hepatic parenchyma. Needle biopsy of the gall bladder was performed. Histopathology of the biopsy is shown (# Figure 3). Immunohistochemical analysis showed tumor cells were positive for CD56, synaptophysin, chromogranin, CK 20, Ki67 and negative for TTF1, CK7 favoring gastrointestinal origin of NEC. Positron Emission Tomography (PET) Scan showed extensive involvement (#Figure 2). He was started on palliative chemotherapy and eventually made comfort care per his request.Discussion: Definitive diagnosis of NEN requires histopathology and immunohistochemical analysis. Radiological imaging studies are helpful in staging. Surgery along with chemotherapy is the gold standard for the early detected cancers. Palliative chemotherapy has been used in tumors with advanced stage and widespread metastasis. Increasing tumor size, depth of invasion and metastasis are associated with the worse prognosis. Gastroenterologist should be aware of this rare and aggressive carcinoma and consider NEN gallbladder in the differential diagnosis of gallbladder mass. Differentiating large cell NEC from other types of cancers is essential given the different treatment options and higher mortality rate of NEC approaching 83% in 5 years and median survival of 11 months after diagnosis.Histopathological classification of the Neuroendocrine Neoplasms. (NEN)PET scan images showing, FDG (Fluorodeoxyglucose) Avid Liver mass Contiguous with Gallbladder with extensive Retroperitoneal, Portacaval and Left Supraclavicular Lymphadenopathy in our patient with known diagnoses of the Large Cell Neuroendocrine Carcinoma of the Gallbladder.Right Lobe of the Liver/Gallbladder mass core biopsy showing poorly differentiated carcinoma consistent with Large Cell Neuroendocrine Carcinoma. Foci of individual cell necrosis and Mitosis are present. (H AND E 400X. INSET 40X)Disclosures:Samyak Dhruv indicated no relevant financial relationships. Dhineshreddy Gurala indicated no relevant financial relationships. Abhishek Polavarapu indicated no relevant financial relationships. Anupma Agarwal indicated no relevant financial relationships. Jocelyn Villanueva indicated no relevant financial relationships. Stephen Mulrooney indicated no relevant financial relationships.

P0270 (S1514). Pancreatic Neuroendocrine Tumor Caught by “Complication” 1389175 Andrea DeCino University of Texas Health Science Center Pancreatic Neuroendocrine Tumor Caught by “Complication” Biliary/Pancreas ePoster Session Andrea DeCino, MD, Laura Rosenkranz, MD; University of Texas Health Science Center, San Antonio, TXIntroduction: ERCP related complications occur at an incidence of 15-30%. Stent induced ductal perforations are rare (0.01-0.1% of ERCPs). We present the fortunate discovery of a pancreatic NET (neuroendocrine tumor) heralded by the unfortunate events of hemosuccus pancreatitis (HP) and ductal and parenchymal perforations.Case Description/Methods: A 38-year-old Hispanic woman with Recurrent Acute Pancreatitis and Pancreatic Divisum who previously underwent related endotherapy at an outside institution, presented with severe abdominal pain. Contrasted CT, MRCP, and EUS revealed two focal strictures in the dorsal pancreatic duct. No parenchymal lesions were noted. ERCP was performed with placement of a pancreatic duct stent bridging both strictures.Three weeks following the procedure, the patient presented with syncope, hematemesis, and hematochezia. Physical exam was notable for epigastric tenderness to palpation. Lipase was 2840 IU/L and hemoglobin was 8.4 G/dL.No source of bleeding was identified on either upper or lower endoscopy. On CT angiogram, intraductal stent was visualized without adjacent pseudocyst, pseudoaneurysm, or evidence of pancreatitis. This time, ERCP revealed a trivial amount of blood oozing from the minor ampulla, which was treated with injection of diluted Epinephrine (Fig A). The existing pancreatic stent was removed in its entirety, and a new pancreatic stent was placed over the guidewire. Within several days, the patient developed severe abdominal pain associated with significant rise in amylase and lipase, and a CT scan revealed pancreatic duct rupture with stent extension into the peritoneum (Fig B and C). The patient later underwent distal pancreatectomy with pancreaticojejunostomy. The explanted pancreatic tail contained a well differentiated 2.2cm NET. Over the next four years, the patient remained tumor free with no evidence of metastatic disease.Discussion: We speculate our patient's NET, undetected by all imaging modalities utilized, was the culprit of the two pancreatic duct strictures and caused obstruction of the PD, leading to deviation of stent trajectory, even though placed over the guidewire, and ultimately perforation of the duct and the pancreatic parenchyma.Our patient's source of bleeding was felt to be hemosuccus pancreaticus, as no other source of bleeding was identified. HP is undetected on endoscopy in 60% of patients. NETs may manifest clinically with recurrent pancreatitis and HP, as evidenced in our patient's case.Fig A. Slow mucosal bleed at the minor ampulla during ERCPFig B. Axial image of pancreatic stent extension into the peritoneum by contrast-enhanced computed abdominal tomographyFig C. Coronal image of pancreatic stent extension into the peritoneum by contrast-enhanced computed abdominal tomographyDisclosures:Andrea DeCino indicated no relevant financial relationships. Laura Rosenkranz indicated no relevant financial relationships.

P0280 (S1524). Painless Jaundice: A Rare Case of Isolated Metastatic Melanoma Mimicking Pancreatic Cancer 1389309 Nermila Ballmick MountainView Hospital / Sunrise Health GME Consortium / HCA Painless Jaundice: A Rare Case of Isolated Metastatic Melanoma Mimicking Pancreatic Cancer Biliary/Pancreas ePoster Session Nermila A. Ballmick, MD, Rylee McCracken, DO, Ann M. Wierman, MD, Hossein Akhondi, MD, Jonathan Wong, MD; MountainView Hospital / Sunrise Health GME Consortium / HCA, Las Vegas, NVIntroduction: Pancreatic cancer is the third most common cause of cancer deaths in the United States. It is considered largely incurable with a 1-year survival rate of 20% and 5-year survival rate of 7%. Meanwhile, isolated pancreatic metastases (IPM) are rare and represent about 2% of all pancreatic tumors. Determining pancreatic masses as either primary or metastatic malignancies can be difficult. Therefore, diagnostic imaging tools such as EUS-FNA with biopsy and effective sampling for immunohistochemistry (IHC) are paramount in dictating treatment options such as surgery, chemotherapy, immunotherapy, and/or radiation.Case Description/Methods: 75-year-old man with history of melanoma of the knee status-post curative wide local resection in 1997 presents with painless jaundice of two weeks. Total bilirubin was 14.1 mg/dl with direct bilirubin of 11.5. AST was elevated at 1549, ALT 1682, and ALP 3889. CEA and CA 19-9 were negative. CT of abdomen showed a pancreatic head mass with dilation of the extrahepatic, intrahepatic, cystic, and main pancreatic ducts favoring adenocarcinoma. ERCP demonstrated a large, friable ampullary mass and EUS revealed the pancreatic head mass invading into the superior mesenteric vein with tumor thrombus. FNA biopsies from the ampulla and pancreatic head were positive for S-100 and Sox-10. He was ultimately diagnosed with malignant melanoma with metastasis to the pancreatic head and biliary tract. IV interferon was started until the biliary obstruction resolved, followed by nivolumab and ipilimumab therapy. He achieved significant shrinkage in tumor size with immunotherapy and targeted radiation.Discussion: IPM is a rare phenomenon that represents 1% of metastatic melanomas. Patients with melanoma and distant metastases have a median survival of less than 1 year. Differentiating pancreatic metastases from a primary malignancy is challenging, but it is essential for optimal treatment and can influence whether surgical or non-operative management is feasible. EUS-FNA biopsy is a useful diagnostic tool that allows for effective sampling since imaging alone with CT and/or MRI cannot distinguish benign or primary pancreatic tumors from metastatic lesions. This case serves to highlight the uncommon presentation of isolated metastatic melanoma and its spread to the GI tract 22 years after initial presentation. It emphasizes the importance of proper history taking, diagnostic work-up of a pancreatic mass, and adequate tissue sampling using various imaging and procedural modalities.(A) CT abdomen with contrast illustrating 4.5 x 2.7 x 3.3 cm pancreatic head mass as indicated by yellow circle.(B) Application of Endoscopic Ultrasound (EUS) with fine needle aspiration (FNA) and biopsy of pancreatic head mass.Disclosures:Nermila Ballmick indicated no relevant financial relationships. Rylee McCracken indicated no relevant financial relationships. Ann Wierman indicated no relevant financial relationships. Hossein Akhondi indicated no relevant financial relationships. Jonathan Wong indicated no relevant financial relationships.

P0290 (S1534). Isolated Superior Mesenteric Artery Dissection as a Mimicker of Acute Pancreatitis 1389763 Rahil Shah Jackson Memorial Hospital Isolated Superior Mesenteric Artery Dissection as a Mimicker of Acute Pancreatitis Biliary/Pancreas ePoster Session Rahil H. Shah, MD1, Juan Carrere, MD2, Brian Baigorri, MD3, Daylem Antunez, MD2; 1Jackson Memorial Hospital, Miami, FL; 2Gastro Health, Miami, FL; 3Intellirad Imaging, Miami, FLIntroduction: Arterial dissections is a tear in the arterial wall creating a false lumen. Mesenteric dissections may occur as a continuation of aortic dissections, but isolated dissections are much rarer. Isolated superior mesenteric artery dissection, ISMAD, has a nonspecific presentation with the potential for high morbidity and mortality. We report the case of a 64-year-old male with an ISMAD that clinically and radiologically mimicked acute pancreatitis.Case Description/Methods: A 64-year-old Hispanic male with a past medical history significant for hypertension presented with abdominal pain for 24 hours. Pain began after a fatty meal and was located periumbilical with radiation to the back. He had nausea and two bouts of vomiting. His vitals were normal except for elevated blood pressure (170/87). Physical examination was only remarkable for tenderness to palpation in the epigastric and periumbilical regions.CBC showed leukocytosis with a left shift. Lipase was normal. Abdominal CT without contrast showed distorted anatomy and inflammation around the head of the pancreas. Abdominal CT with contrast revealed a proximal superior mesenteric artery dissection flap measuring 0.5 cm that started 4 cm from the SMA origin. (Image 1) The actual length including thrombosed false lumen is 8.5 cm. The point of greatest luminal narrowing of the true lumen is 74% (Image 2). It was characterized as a type 2b SMA dissection.The patient was hemodynamically stable and managed conservatively with IV heparin drip and blood pressure control. He was discharged on oral coagulation with a target INR of 2-3.Discussion: ISMAD is a rare disease with a nonspecific presentation. This case report demonstrates how ISMAD may present very similarly to acute pancreatitis. There has been no previous case report which shows an ISMAD mimicking acute pancreatitis. The patient technically met the Atlanta classification for acute pancreatitis with clinical signs and radiographic evidence. However, it is not clear if the inflammation seen radiographically is due to the ISMAD or from cellular injury innately from the pancreas.There are currently no guidelines on treatment strategy for ISMAD. For hemodynamically stable patients, conservative management with anticoagulation, and blood pressure control is recommended. Endovascular and surgical intervention should be considered for patients who are hemodynamically unstable or have an enlarging dissection. This case highlights the importance of a complete workup for abdominal pain.Abdominal CT with IV contrast showing the ISMAD at the level of the fenestration.Abdominal CT scan with IV contrast showing the area of greatest luminal narrowing, approximately 74% narrowing of the true lumen.Disclosures:Rahil Shah indicated no relevant financial relationships. Juan Carrere indicated no relevant financial relationships. Brian Baigorri indicated no relevant financial relationships. Daylem Antunez indicated no relevant financial relationships.

P0300 (S1544). An Interesting Presentation of Cholangiocarcinoma: Esophageal Varices 1390568 Sean Sullivan Albert Einstein Medical Center An Interesting Presentation of Cholangiocarcinoma: Esophageal Varices Biliary/Pancreas ePoster Session Sean Sullivan, DO, Nathan Davis, DO, Yogesh Govil, MD; Albert Einstein Medical Center, Philadelphia, PAIntroduction: Esophageal varices are an uncommon presentation for cholangiocarcinoma.Case Description/Methods: A 75 year old female with a past medical history of anemia presented to her primary care physician with a complaint of fatigue for two months. The patient took NSAIDs regularly, but denied any melena, hematochezia or hematemesis. Lab work confirmed iron deficiency anemia, she was referred for upper endoscopy and colonoscopy. Findings were notable for grade I varices in the lower third of the esophagus and grade I internal hemorrhoids. Given the findings of varices, she was referred for a RUQ ultrasound with findings of cirrhosis without evidence of portal hypertension. The patient had no history of alcohol abuse or viral hepatitis, so these findings were concerning for a diagnosis of NASH. The patient was hospitalized after developing jaundice, abdominal distension and a 15-pound weight loss with associated clay colored stools and dark urine. At the time of admission, her total bilirubin was 22. MRI of the abdomen revealed intrahepatic and extrahepatic bile duct dilation with abrupt narrowing suspicious for stricture. Other findings included cirrhosis, esophageal varices, mild ascites, and mild splenomegaly. The patient underwent ERCP with findings of moderate dilation of the upper and middle third of the main bile duct, left and right hepatic ducts, all intrahepatic branches and the common hepatic duct. A biliary sphincterotomy was performed and 1 stent placed. Brushings of the common bile duct were notable for cholangiocarcinoma. A subsequent PET scan demonstrated mild avidity in the area of the CBD but no discrete lesion and no metastatic disease.Discussion: Cancer arising from the perihilar region accounts for 60-70% of extrahepatic cholangiocarcinomas and are further classified according to the pattern of involvement of the hepatic ducts. Tumors involving the hepatic duct bifurcation, hilar cholangiocarcinomas, are collectively called Klatskin tumors. Patients with extrahepatic cholangiocarcinomas become symptomatic when there is obstruction of the biliary drainage system. Typical presenting symptoms include dark urine, jaundice, clay colored stools, weight loss, and abdominal pain. Small extrahepatic bile duct cancers may not be visualized on imaging, but an obstructing malignant lesion is suggested by ductal dilation in the absence of stones. Proximal lesions cause dilation of just the intrahepatic ducts, while distal lesions cause dilations of both the intrahepatic and extrahepatic ducts.Grade I Esophageal VaricesEsophageal varices in the lower third of the esophagusCommon Bile Duct Dilation on MRIDisclosures:Sean Sullivan indicated no relevant financial relationships. Nathan Davis indicated no relevant financial relationships. Yogesh Govil indicated no relevant financial relationships.

P0310 (S1554). Unusual Mutation in Squamous Cell Carcinoma of Pancreas 1389859 Juan Santiago-Gonzalez University of Puerto Rico School of Medicine Unusual Mutation in Squamous Cell Carcinoma of Pancreas Biliary/Pancreas ePoster Session Juan C. Santiago-Gonzalez, MD1, Ian Da Silva-Lugo, MD1, Jose Sobrino-Catoni, MD1, Jorge Sandelis Pérez, MD2; 1University of Puerto Rico School of Medicine, San Juan, Puerto Rico; 2University of Puerto Rico Medical Sciences Campus, San Juan, Puerto RicoIntroduction: Pancreatic neoplasm is an aggressive malignant tumor of the digestive tract and a leading cause of death related worldwide. Squamous cell carcinoma of pancreas (SCCP) currently has an annual incidence rate of 0.02 cases per 100,000. The diagnosis is made only after excluding other neoplastic lesions of the pancreas that contain squamous epithelial components.Case Description/Methods: A 72 years old male with a history of diabetes mellitus, hypertension and a resected colorectal cancer that three years after resection, developed fatigue, unintentional weight loss, asthenia and anorexia. A contrast Abdominal CT revealed hepatomegaly suggestive of metastatic disease, intrahepatic and extrahepatic biliary duct dilation, and a pancreatic tail mass. CT guided biopsy of liver lesion showed metastatic squamous cells. PET scan identified a hypermetabolic, 3cm soft tissue mass in the left upper quadrant of the abdomen inseparable from the tail of the pancreas. Endoscopic ultrasound fine needle aspiration revealed a moderately differentiated SCCP. Next-generation sequencing came out with six genomic mutations, KRAS, FGFR1, NKX2-1, PBRM1, SPEN, and TP53. The patient was admitted to an oncologic unit where Nanoparticle albumin-bound paclitaxel-gemcitabine regimen was administered. However, due to complications including sepsis, and multi-organ failure, therapy was discontinued. Unfortunately, the patient succumbed to the latter.Discussion: SCCP is a rare entity as squamous cells are naturally absent from the pancreas. However, these can be seen in conditions such as chronic pancreatitis, primary or metastatic carcinoma, and squamous metaplasia related to pancreatic or biliary duct stent placement. Squamous tumours are enriched for TP53 and KDM6A mutations, upregulation of the TP63 transcriptional network, hypermethylation of pancreatic endodermal cell-fate determining genes and have a poor prognosis. Thus, identifying patients who are at high risk to develop pancreatic cancer and who should undergo surveillance has to be a priority. In addition, there is a need to develop tumor markers for early detection, monitoring and treatment purposes. Precursor lesions might represent the opportunity to cure pancreatic neoplasia. With the integration of high throughput sequencing to the clinical practice, valuable information will be obtained. Consequently, providing better understanding of its pathogenesis, improving therapies alternatives and outcomes of pancreatic carcinomas.Pancreas moderately differentiated Squamous Cell CarcinomaMultiple, hypermetabolic, large hepatic lesions, and a 3 cm soft mass in the left upper quadrant, inferior to the stomach and anterior to the spleen inseparable from the tails of pancreas.Disclosures:Juan Santiago-Gonzalez indicated no relevant financial relationships. Ian Da Silva-Lugo indicated no relevant financial relationships. Jose Sobrino-Catoni indicated no relevant financial relationships. Jorge Sandelis Pérez indicated no relevant financial relationships.

P0320 (S1564). Primitive Neuroectodermal Tumor - An Extremely Rare Cancer of Pancreas 1388132 Minhaz Ahmad UHS Wilson Hospital Primitive Neuroectodermal Tumor - An Extremely Rare Cancer of Pancreas Biliary/Pancreas ePoster Session Minhaz Ahmad, MD1, Nazif Chowdhury, MD2, Nasrin A. Chowdhury1, Atif Saleem, MD1; 1UHS Wilson Hospital, Johnson City, NY; 2United Health Services, Johnson City, NYIntroduction: Primitive neuroectodermal tumors (PNETs) are small round cell tumors belonging to the Ewing’s sarcoma family of tumors. They usually occur between the age of 6-25 years and mostly in soft tissues or bones. PNETs may rarely arise from solid organs like pancreas, only 26 cases have been reported so far.We are presenting the 27th case of PNET of pancreas in a 61-year-old male.Case Description/Methods: A 61-year-old male with history of active smoking, alcohol dependence, GERD presented to the ER with worsening abdominal pain associated with nausea, loss of appetite, early satiety and unintentional weight loss of 10 lbs for one month. Abdomen was nontender, distended with hypoactive bowel sound and a large mass was evident on physical exam. Lab showed WBC 14K/UL, AST 32 IU/L, ALT 38 IU/L, ALP 141 IU/L, Ca 10.6 MG/DL, Lipase 162 U/L, PT 15.1 sec, INR 1.29, CEA 2.1 NG/ML, CA 19-9 2 U/ML. CT abdomen with contrast showed a 18.5x11x20 cm cystic mass in the head of the pancreas. Upper GI endoscopy and endoscopic ultrasound revealed severe extrinsic compression by 15x12 cm, septated pancreatic cyst in the gastric body, antrum and prepyloric region causing gastric outlet obstruction. FNAC of the cyst showed no malignancy. With progressive worsening symptoms, he underwent excisional debridement of necrotic pancreatic cyst. Microscopy and immunohistochemistry of the specimen confirmed PNET of pancreas. With mild improvement initially, he continued to have persistent abdominal distention. Repeat CT abdomen showed enlarged cyst to the extent of previous level. Exploratory laparotomy revealed incorporation of cyst cavity into the distal part of the stomach, proximal duodenum, liver and gallbladder. He underwent excision of the pancreatic cyst, cholecystectomy, distal gastrectomy and Roux-en-Y gastrojejunostomy. Pathology revealed invasion of PNET to stomach, duodenum, liver capsule and gallbladder. Repeat CT abdomen showed multiple liver lesions. He was scheduled for outpatient PET scan and oncology follow up.Discussion: The PNETs are aggressive tumors with almost inevitable recurrence and metastasis. Metastasis to the bone, bone marrow, lymph nodes, lung, liver, and other organs have been reported. Currently, the standard treatment of PNETs is complete surgical resection with an adequate margin with systemic chemotherapy and/or radiotherapy. It is difficult to achieve complete resection of PNETs of pancreas because of the adjacent unresectable organs.CT Abdomen with contrast: Pancreatic cystUpper GI Endoscopy : Extrinsic compressionPNET 40x, FLI1 and CD 99Disclosures:Minhaz Ahmad indicated no relevant financial relationships. Nazif Chowdhury indicated no relevant financial relationships. Nasrin Chowdhury indicated no relevant financial relationships. Atif Saleem indicated no relevant financial relationships.

P0330 (S1574). Colorectal Cancer in a Young Male With Primary Sclerosing Cholangitis Without Underlying Inflammatory Bowel Disease 1389370 Tudor Oroian Tripler Army Medical Center Colorectal Cancer in a Young Male With Primary Sclerosing Cholangitis Without Underlying Inflammatory Bowel Disease Biliary/Pancreas ePoster Session Tudor Oroian, MD1, Kyler Kozacek, DO1, Michael Abdo, MD1, Pedro Manibusan, Jr., DO2; 1Tripler Army Medical Center, Honolulu, HI; 2Tripler Army Medical Center, Mililani, HIIntroduction: Primary Sclerosing Cholangitis (PSC) presents with hepatic duct inflammation, fibrosis and stricturing leading to biliary obstruction, recurrent cholangitis and eventually end-stage liver disease. There is a strong association between PSC and Inflammatory Bowel Disease (IBD), especially Ulcerative Colitis (UC), which itself is strongly associated with Colorectal Cancer (CRC) development. Thus, all patients diagnosed with PSC must undergo a colonoscopy to evaluate for concomitant IBD even if asymptomatic at the time of diagnosis. The cumulative absolute risk of CRC or dysplasia in patients with both PSC and UC is approximately 5 to 6 times higher than CRC in UC alone. The classic presentation of PSC is marked by abnormal liver enzymes or cholestatic symptoms. Subsequent colonoscopy identifies underlying IBD in up to 80% of cases which often progresses to CRC. We describe the case of a healthy 29-year-old male newly diagnosed with PSC. Colonoscopy revealed an extremely rare presentation of adenocarcinoma without apparent underlying IBD.Case Description/Methods: 29-year-old active-duty male presented with 6 days of nausea, vomiting, scleral icterus and abdominal discomfort. Initial total bilirubin was 11.7 mg/dL with transaminitis, elevated alkaline phosphatase and CA 19-9. IBD panel and infectious workup were negative. RUQUS and abdominal CT revealed segmental dilatation of common bile duct and mural thickening of the sigmoid colon. Follow-up MRCP / ERCP showed severely stenotic main bile duct limiting further evaluation (Figure 1). Colonoscopy found a hemicircumferential, ulcerated, friable 4cm x 3cm mass in the sigmoid colon, with otherwise normal colonic mucosa (Figure 2). Histologic examination demonstrated invasive poorly differentiated adenocarcinoma. His bilirubin continued to rise to 19.4 mg/dL and required biliary drain placement. Subsequent CT chest showed multiple scattered, solid nodules and the patient was transferred for further staging and potential liver transplant.Discussion: This case is notable as our patient’s PSC diagnosis was immediately followed by the discovery of colon adenocarcinoma without underlying IBD. Though IBD in patients with PSC tends to be asymptomatic at the time of diagnosis, the endoscopic and histologic appearance of the colon is nearly always consistent with underlying IBD. This case exemplifies that PSC may be a direct risk factor for the development of CRC even in the absence of underlying IBD.Figure 1: ERCP with limited contrast transmission (arrow) due to the severely stenosed main bile duct.Figure 2: Fungating Sigmoid Colon lesion prior to biopsy.Disclosures:Tudor Oroian indicated no relevant financial relationships. Kyler Kozacek indicated no relevant financial relationships. Michael Abdo indicated no relevant financial relationships. Pedro Manibusan indicated no relevant financial relationships.

P0340 (S1584). Autoimmune Exocrine Pancreatic Insufficiency: A Novel Paraneoplastic Mechanism for Diarrhea in Patients With Thymoma 1388313 Nadeen Hussain Yale University, School of Medicine Autoimmune Exocrine Pancreatic Insufficiency: A Novel Paraneoplastic Mechanism for Diarrhea in Patients With Thymoma Biliary/Pancreas ePoster Session Nadeen Hussain, MD1, Saad Saffo, MD1, Katherine Gielissen, MD, MHS-Med Ed1, Kenneth H. Hung, MD, MS2; 1Yale University, School of Medicine, New Haven, CT; 2Yale School of Medicine, New Haven, CTIntroduction: Paraneoplastic syndromes are an exceedingly rare cause of chronic diarrhea. Thymomas have been associated with two known paraneoplastic diarrheal syndromes, namely in the context of hypogammaglobulinemia (Good’s syndrome) or a graft-versus-host disease (GVHD)-like condition. However, exocrine pancreatic insufficiency has yet to be reported as a cause of diarrhea in patients with thymoma.Case Description/Methods: A 36-year-old woman with no known medical morbidities presented with postprandial watery diarrhea, emesis, and 100-lb unintentional weight loss over two years. Labs were notable for lymphocytosis up to 8,100/mL with normal flow cytometry and no abnormalities on blood smear. Celiac disease serologies and stool infectious studies were negative. Immunoglobulin G levels were elevated at 3,010 mg/dL, and stool pancreatic elastase levels were low (< 15 mg/g). Additional labs were consistent with fat soluble vitamin deficiency: vitamin A < 5 mcg/dL, 25-hydroxyvitamin D < 4 ng/dL, vitamin E 7 mg/L, vitamin K 69 pg/mL. Computed tomography (CT) of the chest revealed an 11-cm anterior mediastinal mass with pleural and nodal metastases, and biopsy was suggestive of malignant thymoma (Figure 1). CT of the abdomen revealed a normal-appearing pancreas. Subsequent endoscopy and colonoscopy showed healthy-appearing mucosa with no abnormalities (Figure 2). However, colonic biopsies were notable for mild diffuse inflammatory changes including scattered intraepithelial lymphocytes and neutrophils, increased apoptotic bodies, and crypt architectural distortion. Her diarrhea ultimately improved after four cycles of induction chemotherapy.Discussion: GVHD-like colitis in patients with malignant thymoma has been reported in several instances. This has been attributed to alterations in the thymic microenvironment, which lead to dysregulation and loss of anergy. Autoreactive T-cells can mount an immune response that impacts a number of organs, especially in the gastrointestinal tract. Although our patient had histopathological changes reflective of colitis secondary to GVHD, the severity of her diarrhea was out-of-proportion to these findings. The postprandial nature of her symptoms and markedly low stool pancreatic elastase were suggestive of possible pancreatic insufficiency, likely secondary to an autoimmune phenomenon impacting the exocrine glands of the pancreas. This case proposes a possible novel paraneoplastic mechanism for diarrhea in patients with thymoma.Cross-section image of anterior mediastinal massNormal-appearing duodenal mucosaDisclosures:Nadeen Hussain indicated no relevant financial relationships. Saad Saffo indicated no relevant financial relationships. Katherine Gielissen indicated no relevant financial relationships. Kenneth Hung indicated no relevant financial relationships.

P0350 (S1594). Endoscopic Management as a Viable Therapy for Pancreaticopleural and Pancreaticopericardial Fistulas 1387779 Sandy Chan UMass Memorial Medical Center Endoscopic Management as a Viable Therapy for Pancreaticopleural and Pancreaticopericardial Fistulas Biliary/Pancreas ePoster Session Sandy Chan, MD, Matthew Petersile, MD, Jaroslav Zivny, MD; UMass Memorial Medical Center, Worcester, MAIntroduction: Pancreatic fistulas are rare complications of chronic pancreatitis, typically caused when disruption of the pancreatic duct causes leakage of pancreatic fluid that erodes through neighboring organs and structures. Pancreaticopleural and pancreaticopericardial fistulas are extremely rare and management of these fluid collections is challenging with no consensus described in the current literature. We present a case of a patient with concurrent pancreaticopericardial and pancreaticopleural fistulas who improved with endoscopic management.Case Description/Methods: A 53-year-old female with a history of chronic pancreatitis complicated by pseudocysts presented with abdominal pain, shortness of breath, nausea and vomiting. Initial lab work was unremarkable. CT scan of the chest and abdomen showed a new large pericardial and new large right sided pleural effusion. A stat echocardiogram revealed cardiac tamponade and urgent pericardiocentesis was performed. Fluid studies showed an elevated lipase suggesting possible communication between the fluid collections and pancreas. Thoracentesis was unsuccessful due to the high fluid viscosity. Further review of the CT scans revealed concern for a pancreaticopleural and pancreaticopericardial fistula. The surgery team declined operative intervention citing a concern that without endoscopic drainage the effusions may reaccumulate. An ERCP was performed with fluoroscopic images demonstrating a fistula tracking from the main pancreatic duct into the mediastinum. A plastic stent was placed in the pancreatic duct to allow for drainage. A repeat CT Chest one week after ERCP showed significant improvement in pleural effusion without additional intervention. Repeat ERCP four weeks after initial ERCP showed no contrast extravasation out of the pancreas suggesting resolution of the fistulas.Discussion: Pancreaticopleural and pancreaticopericardial fistulas are rare and their management is not well defined. Prior case reports have focused on externally draining the fluid collections with a few cases of endoscopic management described. Fistulous tracts that are bridged endoscopically with stents have a healing rate of over 90%. However, the fistula in our patient closed with pancreatic duct drainage only despite the fact that the fistulous tract was unable to be stented. Our case demonstrates that appropriate endoscopic drainage can be a viable therapy and should be considered in the management of pancreaticopleural and pancreaticopericardial fistulas.Disclosures:Sandy Chan indicated no relevant financial relationships. Matthew Petersile indicated no relevant financial relationships. Jaroslav Zivny indicated no relevant financial relationships.

P0360 (S1604). Sump Syndrome: A Forgotten Complication From the Pre-ERCP Era 1388265 Ricardo López-Valle VA Caribbean Healthcare System Sump Syndrome: A Forgotten Complication From the Pre-ERCP Era Biliary/Pancreas ePoster Session Award: Presidential Poster AwardRicardo López-Valle, MD1, Andrés Rabell-Bernal, MD1, Juan Feliciano-Figueroa, MD, BS2, Henry De Jesus-De La Cruz, MD1, Eduardo Acosta-Pumarejo, MD1, Jaime Martínez-Souss, MD1, José Martin-Ortiz, MD1; 1VA Caribbean Healthcare System, San Juan, Puerto Rico; 2University of Puerto Rico School of Medicine, San Juan, Puerto RicoIntroduction: Bacteremia of unknown origin is a challenging clinical scenario which may be encountered in the internal medicine ward. Etiologies like foreign bodies, bacterial endocarditis, or infected endovascular grafts are common sources. In this case we showcase an unusual presentation of a forgotten syndrome.Case Description/Methods: This is the case of a 71-year-old male with past medical history of hypertension and diabetes who presented to the hospital with symptoms of fever and chills since one day prior. The patient reported that these symptoms started suddenly without any inciting event. He denied any other symptoms on review of systems. Physical exam at that time was unremarkable. Initial labs were only remarkable for mild neutrophilia without associated leukocytosis and mild transaminitis. Blood cultures were taken and given clinical stability the patient was discharged home from the ER. The following day the patient was recalled after blood cultures results returned positive for E. coli and E. faecalis. Remarkably, this patient had been admitted 2 years prior with the exact clinical scenario, the same bacterial portfolio, and no clear etiology was elucidated at that time. Patient was admitted and work-up was performed in an attempt to find a plausible etiology. In view that the above mentioned cultured pathogens usually originate from the gastrointestinal tract, an abdominopelvic CT scan was requested. Interestingly, a very unique finding was described on the imaging study: pneumobilia and a dilated common bile duct. A thorough medical/surgical history revealed that, ten years prior, the patient had undergone a cholecystectomy with a choledochoduodenostomy due to an incidental finding of a porcelain gallbladder and a distal common bile duct benign stricture. Due to his surgical history, pneumobilia in the intrahepatic ducts and a dilated common bile duct were concluded to be expected findings in this patient’s abdominopelvic CT scan. Since there were no other etiologies that could explain the bacteremia, Sump Syndrome was diagnosed.Discussion: Sump syndrome is a rare long-term complication of choledochoduodenostomy. In this type of surgery, the distal limb of the common bile duct may become a reservoir of bile due to a low flow state functioning as a sump. This can lead to complications such as bacterial overgrowth, like in the case above, and eventually lead to recurrent bacteremia.Bile sumpBile sumpBile sumpDisclosures:Ricardo López-Valle indicated no relevant financial relationships. Andrés Rabell-Bernal indicated no relevant financial relationships. Juan Feliciano-Figueroa indicated no relevant financial relationships. Henry De Jesus-De La Cruz indicated no relevant financial relationships. Eduardo Acosta-Pumarejo indicated no relevant financial relationships. Jaime Martínez-Souss indicated no relevant financial relationships. José Martin-Ortiz indicated no relevant financial relationships.

P0490 (S1612). Malignant Melanoma Presenting as Cancer in the Colon 1390269 Ashley Maveddat Texas Tech University Health Sciences Center Malignant Melanoma Presenting as Cancer in the Colon Colon ePoster Session Ashley Maveddat, BA, Sameer Islam, MD, Ebtesam Islam, MD, PhD; Texas Tech University Health Sciences Center, Lubbock, TXIntroduction: Malignant melanoma is known to aggressively metastasize, with common sites in the lungs, liver and lymph nodes. Rare sites of metastasis include the GI tract, presenting with symptoms of GI bleeding, abdominal pain, weight loss, or bowel obstruction with an incidence rate of 0.18-2% of patients. In this case, we present a patient with biopsy-proven cutaneous primary melanoma metastasizing to the colon.Case Description/Methods: A 59-year-old Caucasian male with a past medical history of excised cutaneous right auricular malignant melanoma at age 52 with right neck lymph node dissection due to metastasis presented at age 56 for his first screening colonoscopy, despite a family history of colon cancer. Biopsies of two pedunculated polyps indicated no dysplasia. The patient presented two years later due to an abnormal CT, noting inflammation in the stomach, and intermittent left lower quadrant abdominal pain. At this time, the patient had a follow-up PET scan indicating no abnormal FDG uptake areas, thus suggesting no metastasis. Colonoscopy revealed a villous and ulcerated 4 cm hepatic flexure mass (Figure 1).Pathology of the mass revealed SOX-10 immunostain positive, specific for melanoma, with lymph node involvement (Figure 2 and 3). Thus, a right hemicolectomy with partial omentectomy was performed. He was started on combination immunotherapy for 4 months, with Nivolumab therapy every 14 days for the past year. Follow up CT/PET scan and one-year colonoscopy was stable.Discussion: Malignant melanoma is a tumor of melanocytes derived from neural crest cells commonly found in the skin. Other sites derived from neural crest cells include the GI tract and brain. The incidence of metastatic melanoma to the colon, rectum, and anus at 0.18-2.1%. The diagnosis of metastatic melanoma is largely made by CT and PET scan. The sensitivity of CT scan is 60-70%, thus it is important to perform other studies such as PET scans and colonoscopies if CT results are negative. Biopsy of masses with special immunostain, including SOX-10 and S100, confirms the diagnosis of metastatic melanoma. Surgical intervention has been used for patients with curative intent. Mean survival from diagnosis of large bowel metastasis is reported to be 31.7 months, with 1-year survival of 67.9%, 2-year survival of 50.5% and 5-year survival of 22.9%. The two most important prognostic factors for long-term survival ARE resection with curative intent and the GI tract as the initial site of distant metastasis.Figure 1: Villous, ulcerated mass at the hepatic flexure measuring 0.2 x 0.2 x 0.2 cm and 0.3 x 0.1 x 0.1 cmFigure 2: Tumor cells expressing SOX-10 (50X)Figure 3: The metastatic tumor cells expressing SOX10 in lymph node (100X)Disclosures:Ashley Maveddat indicated no relevant financial relationships. Sameer Islam: Allergen – Speaker's Bureau.Ebtesam Islam indicated no relevant financial relationships.

P0500 (S1622). Rapid Onset Colitis Following Single Infusion of Combination Checkpoint Inhibitor Therapy 1389807 Jeffrey Prochot Advocate Lutheran General Hospital Rapid Onset Colitis Following Single Infusion of Combination Checkpoint Inhibitor Therapy Colon ePoster Session Jeffrey Prochot, DO, Ryan T. Hoff, DO, Scott Siglin, MD; Advocate Lutheran General Hospital, Park Ridge, ILIntroduction: Checkpoint inhibitors are becoming more prevalent due to a growing number of oncologic indications. Colitis due to ipilimumab and nivolumab are well described adverse effects, but onset and severity can vary. We present a case of severe checkpoint inhibitor induced colitis five days after infusion. Case Description/Methods: A 68-year-old man was admitted for diarrhea. Five days prior, he received his first dose of ipilimumab and nivolumab combination therapy for metastatic prostate cancer, as a part of a clinical trial. He described up to 10 watery bowel movements per day with abdominal pain. Flexible sigmoidoscopy confirmed severe colitis. Biopsies showed acute inflammation, crypt abscesses, and cryptitis consistent with checkpoint inhibitor induced colitis. He was treated with IV steroids and transitioned to oral before discharge. His diarrhea persisted and he was given high dose steroids. After two weeks with no improvement, he was given an infusion of infliximab. Despite this, he was readmitted to the hospital. He received IV steroids and a second dose of infliximab. Four days later, he developed severe abdominal pain with guarding. CT showed pneumoperitoneum, requiring emergent surgery for cecal perforation (fig.1). Surgical pathology showed focal serositis, multifocal mucosal/submucosal inflammation and crypt microabscesses (fig. 2 & 3). Follow up sigmoidoscopy showed improved inflammation. After an extended steroid taper, he was discharged. Discussion: Ipilimumab and nivolumab are immune checkpoint inhibitors used to treat metastatic melanoma and renal cell carcinoma, with ongoing trials for metastatic prostate cancer (1). Diarrhea and colitis are common adverse reactions of these medications, with an incidence of up to 44% (1). Average onset of colitis is 5-10 weeks after the third infusion for both ipilimumab and nivolumab (2). Management is based on symptom severity. Grade 1-2 diarrhea may only require interruption of infusions, whereas grades 3-4 diarrhea should be treated with IV steroids (1). Infliximab is effective for steroid refractory disease. Vedolizumab has recently been used in patients unresponsive to steroids and infliximab (3). To our knowledge, this case represents the earliest onset of colitis following immune checkpoint inhibitor therapy. Early diagnosis with endoscopy is key, as this allows for directed treatment, which may decrease the risk of complications. It is important for the physician and patient to be aware of these side effects to ensure prompt treatment. CT abdomen with IV contrast showing pneumoperitoneum, with free air due to cecal perforation.Surgical specimen following exploratory laparotomy with right hemicolectomy for cecal perforation.Histology showing multifocal mucosal/submucosal inflammation and crypt microabscesses.Disclosures:Jeffrey Prochot indicated no relevant financial relationships. Ryan Hoff indicated no relevant financial relationships. Scott Siglin indicated no relevant financial relationships.

P0510 (S1632). Colo-Colonic Intussusception 1387722 Yazan Hasan University of Iowa Hospitals and Clinics Colo-Colonic Intussusception Colon ePoster Session Yazan Hasan, MBBS1, Mahmoud Soubra, MD2; 1University of Iowa Hospitals and Clinics, North Liberty, IA; 2University of Iowa Hospitals and Clinics, Iowa City, IAIntroduction: Colo-colonic intussusception has been rarely reported in the literature.[1, 2] Most causes are due to adhesions, motility disorders, colonic masses or inflammatory conditions.[1] Colonic lipomas are benign non-epithelial adipocyte hyperplasia of the gastrointestinal tract and are the second most common benign colon tumors. Rarely, they can cause complications such as abdominal pain, hematochezia, intestinal obstruction, or intussusception particularly if the lipoma is larger than 2 cm.[3]Case Description/Methods: A 57 year-old-man presented to the outpatient clinic with intermittent abdominal pain and hematochezia for 2 months. CT abdomen revealed a colo-colonic intussusception in the descending colon (Figure A) with a 3 cm mass acting as a leading point (Figure B). Colonoscopy showed a 3 cm polypoid lesion with surface ulceration (Figure C). This was probed with a biopsy forceps and had a positive pillow sign consistent with a lipoma. As the mass was large and causing symptoms, a decision was made to proceed with endoscopic snare resection using blended cautery current (ENDO CUT Effect 2; Erbe USA Inc, Marietta, GA). Histologic examination was consistent with benign lipoma. Post procedure, he developed abdominal pain, fever and leukocytosis without evidence of perforation on repeat imaging in keeping with post-polypectomy electrocoagulation syndrome. He was managed conservatively with good response and discharged home 48 hours later.Discussion: Colo-colonic intussusception contributes to 17% of all intestinal intussusceptions in adults [2, 4]. The clinical presentation is highly variable [5]. Colo-colonic intussusception due to colonic lipomas is rare with a reported incidence between 0.035% and 4.4% [6]. The majority of cases occur in the right colon. Most patients with colonic lipomas are asymptomatic and are incidentally found during colonoscopy. Only 25% of patients develop symptoms [4]. Due to their intramural location, lipomas can serve as a leading point for intussusceptions [7]. Management depends on the size of the lipoma and the presenting symptoms. However, there is no proper guidelines to determine the size where endoscopic or surgical resection should be performed. Historically, most patients with large colonic lipomas causing symptoms have undergone surgical resection. More recently, several successful endoscopic methods have been reported with excellent results and low complication rate [8-10].Figure AFigure BFigure CDisclosures:Yazan Hasan indicated no relevant financial relationships. Mahmoud Soubra indicated no relevant financial relationships.

P0520 (S1642). Pay Attention to the Appendix During Colonoscopy. You Might Save Your Patient From a Cancer! 1389378 Dong Joo Seo Roger Williams Medical Center Pay Attention to the Appendix During Colonoscopy. You Might Save Your Patient From a Cancer! Colon ePoster Session Dong Joo Seo, MD, Praneet Srisailam, MD, Nabil Toubia, MD; Roger Williams Medical Center, Providence, RIIntroduction: Appendiceal mucoceles(AM) are uncommon cystic neoplasms characterized by distension of the appendiceal lumen with mucus.The incidence is 0.2%-0.4% of all appendectomied specimens. AM may be benign or malignant. Due to a lack of specific signs and symptoms, this condition is frequently diagnosed incidentally.Case Description/Methods: 58-year-old female with past history significant for diminutive colonic polyps 6 years ago presented to gastroenterology outpatient office for colonoscopy surveillance. Patient was asymptomatic. Physical exam was unremarkable. Then, she was scheduled for the colonoscopy. On appendiceal orifice during the procedure, one small submucosal nodule with mucous secretion was noted and biopsy was taken. Subsequently, patient was referred to a general surgeon for the further evaluation. CT scan of the abdomen was done and showed a normal-size appendix. The biopsy came back positive for benign AM. Patient underwent laparoscopic appendectomy and the specimen was sent to the pathology that showed focal collection of acellular mucinous material without any significant inflammation, epithelial dysplasia or malignancy.Discussion: The choices of method to diagnose appendiceal mucocele are abdominal ultrasound, computed tomography (CT) and colonoscopy. Ultrasound and CT are frequently used as the first line diagnostic method for patient with acute abdominal pain to differentiate between mucocele and acute appendicitis. CT is known to be more accurate only for appendix lumen more than 1.3cm with cystic dilation and/or wall calcification. These imaging modalities are also used to select appropriate surgical procedure in order to prevent intra-operative complications especially peritoneal dissemination. Since the lesion can be directly visualized and biopsied, colonoscopy is the most sensitive and specific test. Generally, the appendiceal orifice is observed in the center of a firm mound covered by normal mucosa or a yellowish, lipoma-like submucosal mass, known as “volcano sign”. Surgical treatment of the AM is mandatory because of the potential for malignant transformation and prevention of pseudomyxoma peritonei. Simple appendectomy is chosen for patients with benign mucoceles whereas right hemicolectomy or partial colectomy are considered for the malignant mucoceles with or without perforation.Protrusion of appendiceal orifice, volcano signDisclosures:Dong Joo Seo indicated no relevant financial relationships. Praneet Srisailam indicated no relevant financial relationships. Nabil Toubia indicated no relevant financial relationships.

P0530 (S1652). Campylobacter and E. coli in a COVID Patient With Diarrhea: A Complicated Scenario 1389749 Kathryn Humes George Washington University School of Medicine and Health Sciences Campylobacter and E. coli in a COVID Patient With Diarrhea: A Complicated Scenario Colon ePoster Session Kathryn Humes, MD1, Katrina Naik, MD2, Juan Reyes, MD1, Farida Izzi, MD1, Nabil Fallouh, MD1, Marie L. Borum, MD, EdD, MPH1; 1George Washington University School of Medicine and Health Sciences, Washington, DC; 2George Washington University, Washington, DCIntroduction: Multiple studies have attempted to characterize the signs and symptoms of infection with SARS-CoV-2 (COVID-19). While fever and respiratory symptoms remain the most common manifestations, gastrointestinal issues including abdominal pain, nausea, vomiting, and diarrhea have been increasingly reported. The etiology of diarrhea in SARS-CoV-2 has not been fully elucidated, but it may be multifactorial. This is a rare case of a COVID-infected patient with diarrhea and multiple gastrointestinal organisms.Case Description/Methods: A 59 year old male nursing home resident presented to the hospital with dyspnea, cough, fever, nausea and diarrhea. On arrival, he was febrile (T 38.1 C), mildly tachycardic with an oxygen saturation of 96% breathing room air. His abdomen was soft with diffuse, mild tenderness. Labs showed a normal white blood cell count, but lymphopenia. His chemistry panel and liver enzymes were normal. D-dimer was elevated > 2. He was SARS-CoV-2 positive. Supportive care and therapeutic anticoagulation was initiated. The next day, the patient continued to have frequent diarrhea with streaking of bright red blood. Stool PCR testing revealed Campylobacter and enteropathogenic E.coli. He was started on azithromycin, his anticoagulation was held, and his hematochezia and diarrhea slowly improved.Discussion: The regular use of antibiotics in acute diarrheal illness is generally not recommended unless the risk of complications from diarrheal illness outweigh the risks associated with antibiotic use. Additionally, in diarrhea associated with Shiga-toxin producing E. Coli strains, antibiotic use is associated with higher rates of hemolytic uremic syndrome. In this patient, it was determined that his symptoms were severe enough to warrant antibiotics. Azithromycin was chosen due to its activity against Campylobacter and the potential benefit in COVID-19 infection due to inherent anti-inflammatory properties.Intestinal inflammation and diarrhea in SARS-CoV-2 has been hypothesized to result from viral damage to ACE-2 receptors. However, the severity of diarrhea in this patient with potentially infectious enteric bacteria prompted antibiotic administration. The presence of multiple gastrointestinal organisms has rarely been reported in COVID patients. It is difficult to determine which enteric organisms are pathogenic and which may be colonizers. Clinicians must carefully evaluate the potential risks and benefits of initiating antimicrobials for diarrhea in patients with SARS-CoV-2.Disclosures:Kathryn Humes indicated no relevant financial relationships. Katrina Naik indicated no relevant financial relationships. Juan Reyes indicated no relevant financial relationships. Farida Izzi indicated no relevant financial relationships. Nabil Fallouh indicated no relevant financial relationships. Marie Borum indicated no relevant financial relationships.

P0540 (S1662). A Rare Case of Metastatic Colonic Involvement of Lingual Squamous Cell Carcinoma 1387869 Sikandar Khan Cleveland Clinic Florida A Rare Case of Metastatic Colonic Involvement of Lingual Squamous Cell Carcinoma Colon ePoster Session Sikandar Khan, MD, Asad Ur Rahman, MD, Michael Castillo, MD, Amir Riaz, MD, Rafael Miret, DO, Pablo Bejarano, MD, Fernando J. Castro, MD; Cleveland Clinic Florida, Weston, FLIntroduction: Squamous cell carcinoma (SCC) of the colon is extremely rare. Although metastasis of SCC of the head and neck has been reported in the small bowel, there have been very few reported cases in literature recognizing spread to the large intestines. We present a rare case of colonic metastasis in the transverse colon from a lingual SCC. To the best of our knowledge, there are no previously reported cases of primary SCC of the tongue metastasizing to the colonCase Description/Methods: 60 year old male was admitted to the ED with worsening fatigue and melena for 2 weeks. His past medical history was significant for stage IV SCC of the tongue (p16+, HPV+), diagnosed 3 years earlier, with metastasis to the lungs and brain. He had undergone surgical resection of the tumor with adjuvant radiation therapy and was receiving Pembrolizumab. He was recently discharged twice from the ED for similar symptoms, as EGD and CT abdomen did not find any acute pathology. On admission, he was hemodynamically stable but cachectic appearing. Lab testing showed a hemoglobin of 4.3 g/dL. His baseline was 7-8 g/dL. He was appropriately transfused and underwent a colonoscopy, which demonstrated an exophytic ulcerated non-obstructing 5 cm mass suspicious for malignant neoplasm in the transverse colon (figure 1). Biopsy of the results showed poorly differentiated SCC with ulceration (figure 2). Stains were positive for p16, similar to the original pathology report from the resected lingual cancer specimen. Due to the progression of the disease on Pembrolizumab, the patient opted for hospice and comfort care and unfortunately passed away five weeks laterDiscussion: In patients with known SCC of the head and neck presenting with melena in the setting of a negative EGD and CT imaging, metastatic disease of the colon should be considered, and a colonoscopy should be included as part the differential workup. In a 2015 study by Irani et al, the most common secondary sites of spread for lingual SCC were found to be the lungs, heart, and skin. Our review of literature found this to be the fourth documented case of metastatic SCC of the colon from a head and neck primary and the first such case with the tongue as the primary site of malignancy (Table 1). Due to the rarity of the disease, no standardized treatment guidelines currently exist for patients with metastatic SCC of the colon. Prompt surgical evaluation and palliative care consultation are often the mainstays of treatmentFigure 1: 5 cm exophytic ulcerated mass in the transverse colonFigure 2: H&E stain showing poorly differentiated squamous cell carcinoma with ulcerationTable 1: Published cases of metastatic SCC of the colon from a head and neck primaryDisclosures:Sikandar Khan indicated no relevant financial relationships. Asad Ur Rahman indicated no relevant financial relationships. Michael Castillo indicated no relevant financial relationships. Amir Riaz indicated no relevant financial relationships. Rafael Miret indicated no relevant financial relationships. Pablo Bejarano indicated no relevant financial relationships. Fernando Castro indicated no relevant financial relationships.

P0550 (S1672). A Case Description of Clostridium Glycolicum and Clostridium Paraputrificum Bacteremia From Complicated Diverticulitis 1390711 Gopala Koneru University of Cincinnati A Case Description of Clostridium Glycolicum and Clostridium Paraputrificum Bacteremia From Complicated Diverticulitis Colon ePoster Session Gopala Koneru, MD1, Vamsi Kantamaneni, MD2, Ishani Shah, MD3, Balaj Rai, MD4, Aditya Kalakonda, MD5; 1University of Cincinnati, Cincinnati, OH; 2Allegheny Health Network, Pittsburgh, PA; 3Creighton University Arizona Health Education Alliance, Phoenix, AZ; 4Christ Hospital, Cincinnati, OH; 5St. Elizabeth Medical Center, Cincinnati, OHIntroduction: Clostridium species are anaerobic gram-positive bacilli that can cause a broad range of invasive infections in humans, including bacteremia and intra-abdominal infections. Clostridium glycolicum and Clostridium paraputrificum in particular are infrequent isolates in bacteremia with incidence less than 1%. We describe a rare case of Clostridium paraputrificum and Clostridium glycolicum bacteremia resulting in septic shock secondary to a diverticular abscess.Case Description/Methods: A 66-year-old female was admitted with high fevers and seizure like activity. She had a history of Non-Hodgkin’s Lymphoma and breast cancer both of which were confirmed to be in remission. Prior to presentation, her husband had noticed the patient acting unusual and staring to the left with a fixed gaze. On arrival to the ER, she had a rectal temperature of 106.5F and needed vasopressor support. A computer tomography (CT) of the head showed no acute abnormalities and multiple lumbar punctures attempted were unsuccessful. She was empirically treated with levetiracetam/fosphenytoin for possible seizures and vancomycin/meropenem/metronidazole for sepsis. CT of the chest, abdomen and pelvis showed sigmoid diverticulitis with an adjacent small foci of gas which may have been a micro-perforation without fluid collections or pneumoperitoneum. Multiple blood cultures grew Clostridium glycolicum and Clostridium paraputrificum. Subsequent CT of abdomen and pelvis demonstrated a sigmoid diverticulitis with an adjacent abscess measuring 2.4 x 1.3 cm (figure 1). She was treated with ceftriaxone and metronidazole for 3 weeks given her allergies to penicillin and ciprofloxacin. The patient is planned to have follow up imaging to check for resolution of the abscess.Discussion: Presumably, the source of our patient's Clostridium bacteremia was the complicated diverticulitis given the imaging findings. Most species of Clostridium are considered to be harmless soil saprophytes but there are a few case reports of these strains causing bacteremia. Clostridium bacteremia in humans is usually caused by dissemination of gut colonizing strains due to disturbed host defenses locally or systemically. In our case, sigmoid diverticulitis could be considered a pre-disposing factor but given her past history she will need an outpatient work-up rule out malignancy. This case should heighten the awareness of these particular clostridium species as a clinically important organism and every effort should be made to investigate them further.Figure 1: Transverse view of a computer tomography of the abdominal/pelvis showing an 2.4 x 1.3 cm abscess (blue arrow) on the anterior wall of the sigmoid colon with reactive thickening of the adjacent urinary bladder wall without evidence of a fistulaDisclosures:Gopala Koneru indicated no relevant financial relationships. Vamsi Kantamaneni indicated no relevant financial relationships. Ishani Shah indicated no relevant financial relationships. Balaj Rai indicated no relevant financial relationships. Aditya Kalakonda indicated no relevant financial relationships.

P0560 (S1682). Appendiceal Goblet Cell Adenocarcinoma 1389391 Joshua McCarron Naval Medical Center Appendiceal Goblet Cell Adenocarcinoma Colon ePoster Session Joshua D. McCarron, MD1, Zachary Neubert, DO1, Angela Bachmann, MD1, Chris Costanza, MD2; 1Naval Medical Center, San Diego, CA; 2Southern California Permanente Medical Group, San Diego, CAIntroduction: Goblet cell adenocarcinoma (GCA) is a rare, aggressive form of malignancy possessing features of both a neuroendocrine tumor and adenocarcinoma. Typical presentation is in the setting of appendicitis, abdominal pain, and diarrhea. We present a 51-year-old patient diagnosed after diagnostic colonoscopy for two-month history of diarrhea.Case Description/Methods: A 51-year-old Hispanic male presented for diagnostic colonoscopy after a two-month history of watery diarrhea. Vital signs, physical exam, blood counts and electrolytes were unremarkable. Colonoscopy performed revealed subtle granular mucosa in the appendiceal orifice without an obvious mass (Fig. 1). Biopsies with cold forceps of the appendiceal orifice and overlying mucosa revealed appendiceal GCA. Computed tomography with IV contrast revealed a dilated appendix (Fig. 2). Surgical evaluation obtained and patient underwent an uncomplicated right-hemicolectomy. A 3 cm tumor invading the visceral peritoneum was excised with negative margins and no evidence of lymph node involvement. Pathology revealed a well-differentiated, mixed GCA (adenocarcinoma ex goblet cell carcinoid) (Fig. 3). Final evaluation denoted stage IIb GCA, which is high risk based on his T4aN0 classification. Medical oncology started the patient on adjuvant chemotherapy with oxaliplatin and capecitabine. Presently, the patient has completed adjuvant chemotherapy without evidence of recurrent disease.Discussion: GCA is a rare malignancy combining the characteristics of neuroendocrine tumors and adenocarcinoma, comprising 13.8% of all primary appendiceal neoplasms with an annual incidence of just 0.017 cases per million patient years. Most patients present with symptoms suggestive of acute appendicitis (acute right lower quadrant abdominal pain, nausea, vomiting, diarrhea, and a palpable abdominal mass) as the appendix is the most common organ afflicted. Given the rarity of this condition, no consensus guidelines exist for its management. Most often, treatment mirrors that of typical adenocarcinomas. Surgical resection is the primary treatment and can be limited to appendectomy if considered stage I. In higher stages, as demonstrated in this case, right hemicolectomy is performed to obtain adequate nodal sampling as metastasis is common. Adjuvant chemotherapy is also recommended in select cases.We present a case of appendiceal goblet cell adenocarcinoma presenting with diarrhea diagnosed by colonoscopy and managed with right hemicolectomy, and adjuvant chemotherapy.Figure 1. Appendiceal orifice with subtle granular mucosa.Figure 2. Computed tomography with intravenous contrast of the abdomen showing dilated appendix (green arrow).Figure 3. The tumor is composed of goblet-like mucinous cells growing in small cohesive groups that lack lumina (example with black arrow). Nuclear atypia is mild and there are infrequent mitoses. (Hematoxylin and eosin stain, 100x).Disclosures:Joshua McCarron indicated no relevant financial relationships. Zachary Neubert indicated no relevant financial relationships. Angela Bachmann indicated no relevant financial relationships. Chris Costanza indicated no relevant financial relationships.

P0570 (S1692). Chronic Cannabis User Presenting With Intussusception: A Diagnostic Challenge and Preventive Implications 1388324 Daniel Yeoun State University of New York Health Sciences University Hospital Chronic Cannabis User Presenting With Intussusception: A Diagnostic Challenge and Preventive Implications Colon ePoster Session Daniel Yeoun, DO, MPH1, Cherif El Younis, MD2, Yasir Ali, MD2, Muhammad F. Ahmed, MD2; 1State University of New York Health Sciences University Hospital, Brooklyn, NY; 2Brookdale University Hospital, Brooklyn, NYIntroduction: Chronic use of cannabis has been associated with frequent and typically self-limited episodes of cannabinoid hyperemesis syndrome. Few cases of transient intussusception have been reported among chronic cannabis users. We report a case of a chronic cannabis user presenting with long-segment intussusception that required intestinal resection.Case Description/Methods: A 54 year old woman, chronic cannabis user, presented with diffuse, cramping abdominal pain. She had prior emergency room visits for similar mild symptoms. Patient denied taking any medications and never had surgery or endoscopy. She used cannabis daily for many years. Examination was remarkable for a soft, mildly distended abdomen with mild diffuse tenderness. Her complete blood count, metabolic panel, electrolytes, lactate, thyroid studies, hemoglobin a1c, HIV, stool tests and pregnancy test were unremarkable. Urine toxicology was cannabinoid positive several times over the past year.CT of the abdomen revealed a long-segment ileocolonic intussusception extending to the mid-transverse colon and she was taken for emergent laparotomy. Intraoperatively, there was no necrosis or masses identified. Due to the long-segment intussusception, she received a right hemicolectomy. She had an uneventful post-operative course.Discussion: Adult idiopathic intussusception without an identifiable lead point is exceedingly rare. A few case reports have associated intussusception with chronic cannabis use as a possible cause. Chronic cannabis use disrupts gastrointestinal motility and slows peristalsis in various bowel segments through chronic activation of cannabinoid receptor type 1 (CB1) located in the submucosal and myenteric nerve plexus. In all similar cases reported among chronic cannabis users, intussusception was transient and reversible. In the case we present, intussusception did not resolve with conservative management and required right hemicolectomy. In patients presenting with intussusception, a complete work-up is necessary to rule out structural abnormalities including malignancy. Intussusception related to chronic cannabis use may be transient and potentially preventable with cessation of cannabis. With the growing use of cannabis worldwide, more complications of cannabis use will be recognized. Awareness of chronic cannabis use as a possible etiology of adult intussusception is important as a potentially preventable and reversible etiology of intussusception.A) XR one month prior to intussusception diagnosis; B) Five days prior to surgery there is interval bowel dilationAxial, coronal, and sagittal views of a long-segment ileocolonic intussusception. Mesenteric fat, vessels, and the appendix can be visualized within the intussusception.Disclosures:Daniel Yeoun indicated no relevant financial relationships. Cherif El Younis indicated no relevant financial relationships. Yasir Ali indicated no relevant financial relationships. Muhammad Ahmed indicated no relevant financial relationships.

P0580 (S1702). Russell Body Colorectal Polyp: Benign Behavior Despite of Clonal Restriction 1390542 Albert Manudhane Warren Alpert Medical School of Brown University Russell Body Colorectal Polyp: Benign Behavior Despite of Clonal Restriction Colon ePoster Session Albert Manudhane, MD, Abbas Rupawala, MD, Evgeny Yakirevich, MD, Diana Treaba, MD; Warren Alpert Medical School of Brown University, Providence, RIIntroduction: Mott cells are a term for plasma cells containing Russell bodies. Colonic lesions containing such Mott cells are extremely rare. Herein, we describe a case of colonic polyp with Russell bodies and Mott cells.Case Description/Methods: A 57-year-old female with a history of ductal carcinoma in situ treated with lumpectomy and radiation underwent a screening colonoscopy. A 10mm sessile polyp was found in the sigmoid colon at the edge of a diverticulum. It had the endoscopic appearance typical of an inflammatory polyp. Attempts at snare polypectomy resulted in the polyp prolapsing into the diverticulum and incomplete resection after multiple attempts. The lesion was highly vascular with mild post polypectomy bleeding that resolved. Histopathology revealed a kappa light chain restricted CD138 and MUM1 positive population of plasma cells with numerous intracytoplasmic Russell bodies and crystals. The final diagnosis was a granulation tissue polyp with monoclonal kappa light chain restricted population of plasma cells with intracytoplasmic Russell bodies and crystals. She was completely asymptomatic other than occasional diarrhea that was thought to be functional. A systemic workup with serum protein electrophoresis, complete blood count, complete metabolic panel, and X-ray skeletal survey did not reveal any abnormalities. A mildly elevated serum kappa/lambda ratio of 2.16 (ref range 0.26-1.65) and free kappa light chain of 20.3 (ref range 3.3-19.4 mg/L) was the only significant finding on testing corresponding to kappa light chain restriction in tissue. Immunofixation electrophoresis did not identify monoclonal paraprotein. Hematology and colorectal surgery felt this was an isolated finding rather than systemic disease and suggested follow-up colonoscopy.Discussion: While Russell body containing lesions have been described in the upper gastrointestinal tract, colorectal lesions are extremely rare and don’t have a generally defined appearance. Of the three previously reported, two were polypoid, one tubulovillous adenoma, another an inflammatory polyp. The third had an endoscopically normal colon but Russell bodies were seen on random colon biopsies. Russell body lesions are benign and believed to form secondary to persistent mucosal inflammation. Usually, as with this case, there is no evidence of systemic disease. This case suggests the importance of biopsying inflammatory polyps on colonoscopy, as the microscopic findings may warrant additional investigation.Sigmoid colon lesion containing Mott cells with Russell bodies using H&E stain (20x).A kappa light chain restricted CD138 positive population of plasma cells with numerous intracytoplasmic Russell bodies and crystals (20x).A kappa light chain restricted MUM1 positive population of plasma cells with numerous intracytoplasmic Russell bodies and crystals (20x).Disclosures:Albert Manudhane indicated no relevant financial relationships. Abbas Rupawala indicated no relevant financial relationships. Evgeny Yakirevich indicated no relevant financial relationships. Diana Treaba indicated no relevant financial relationships.

P0590 (S1712). The Machiavellian Passenger 1390385 Reyshley Ramos-Marquez VA Caribbean Healthcare System The Machiavellian Passenger Colon ePoster Session Reyshley Ramos-Marquez, MD1, Hendrick Pagan-Torres, MD1, Carolina S. Diaz-Loza, MD1, Carlos Fernandez-Cruz, MD1, Priscilla Magno, MD, MSc2; 1VA Caribbean Healthcare System, San Juan, Puerto Rico; 2VA Caribbean Healthcare System, Guaynabo, Puerto RicoIntroduction: Diarrheas affect a great number of individuals worldwide. Chronic diarrheas are defined as increased frequency of loose stools for more than 4 weeks. However, defining the etiology of chronic diarrheas is a challenging task, as ideal strategies for evaluation have yet to be established. Parasitic disease should always be considered as a possible cause in endemic regions. One important parasite to consider is Schistosoma. Clinical manifestations can range from asymptomatic to maculopapular rash, fever, headache, and diarrhea. This is the case of an unusual passenger found in a diagnostic colonoscopy.Case Description/Methods: A 77-year-old Puerto Rican male with past medical history of pulmonary sarcoidosis and Hepatitis B exposure presented with watery diarrhea for the last three years. The patient described about three episodes of loose stools daily aggravated by food intake and associated with abdominal pain and bloating. Physical exam was essentially unremarkable without stigmata of liver disease. Blood workup displayed thrombocytopenia and eosinophilia. Liver enzymes, coagulation parameters, and albumin were all within normal limits. Stool ova and parasites and urine and stool cultures were negative. ESR and CRP were not elevated. Abdominopelvic CT scan and abdominal sonogram were solely remarkable for fatty infiltrations with hepatocellular disease and splenomegaly. As a result, a diagnostic colonoscopy was performed. Random biopsies were obtained from the colon and sub centimeter tubular adenoma in the sigmoid colon. Biopsies from the rectum revealed a small non-necrotizing granuloma with a foreign body type giant cell at rectum suggestive of a parasitic infection. Schistosoma antigen was ordered and yielded a positive result. The patient was subsequently treated with praziquantel, which resulted in resolution of diarrhea and improvement in platelet count.Discussion: Schistosomiasis is a serious infection endemic in the Caribbean and other places around the world. Therefore, this parasite should form part of the differential diagnosis when a patient presents with chronic diarrheas, eosinophilia and thrombocytopenia. Despite stool or urine microscopy being the gold standard for the diagnosis of schistosomiasis, our case illustrates how this is not infallible. The importance of combining social history, clinical presentation, histopathology and serum biomarkers should not be overlooked.Disclosures:Reyshley Ramos-Marquez indicated no relevant financial relationships. Hendrick Pagan-Torres indicated no relevant financial relationships. Carolina Diaz-Loza indicated no relevant financial relationships. Carlos Fernandez-Cruz indicated no relevant financial relationships. Priscilla Magno indicated no relevant financial relationships.

P0600 (S1722). A Rare Case of an Appendiceal Mucinous Cystadenoma 1388740 Kriti Suwal Guthrie/Robert Packer Hospital A Rare Case of an Appendiceal Mucinous Cystadenoma Colon ePoster Session Kriti Suwal, MD, Neeraj Mangla, MD, Michael J. Georgetson, MD, FACG; Guthrie/Robert Packer Hospital, Sayre, PAIntroduction: An Appendiceal Mucinous Cystadenoma (AMC) is a cystic neoplasm of the vermiform appendix associated with marked distension of the appendiceal lumen with mucin. We present a case of non-specific abdominal pain caused by AMC, found in 0.2-0.3% of resected appendices in Europe and the United States.Case Description/Methods: Our patient is a 67 year old female, who presented to her primary care physician with chronic vague abdominal pain and constipation for two months. The pain was dull in nature, located in the upper abdomen and associated with poor appetite. She was started on a proton pump inhibitor and was referred to gastroenterology after reporting no improvement. A contrast enhanced CT scan of abdomen and pelvis revealed a well circumscribed tubular structure invaginating the cecum. She underwent a colonoscopy showing a submucosal non-obstructing, non-circumferential twenty millimeter mass in the cecum. The mass was hard on palpation and biopsies performed were inconclusive. She was referred to general surgery and underwent a combined laparoscopic assisted appendectomy and partial cecectomy, leaving the ileocecal valve intact. The gross specimen revealed a low-grade mucinous cystic neoplasm of appendix. Our patient reported resolution of her abdominal pain and constipation after recovering from surgery.Discussion: Mucinous cystadenoma of the appendix is a rarely reported etiology of non-specific abdominal pain. The most commonly reported symptom of AMC is right iliac fossa pain that may mimic acute appendicitis. A quarter of patients with AMC are asymptomatic and the disease is often found incidentally on imaging or at the time of surgery.CT imaging typically shows a structure containing homogenous hypoattenuating material with Hounsfield Units similar to water density (0-15 HU). Curvilinear calcification in the wall of the appendix is highly suggestive of a mucocele.The definitive treatment of AMC is surgical excision of the tumor. Rupture of the tumor can result in dissemination of mucin-producing cells into the peritoneal cavity leading to pseudomyxoma peritonei, a potentially malignant condition that may require cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for treatment. Misdiagnosis of AMC may lead to prophylactic hemicolectomy or complete cecectomy. Further studies should elucidate commonly found endoscopic findings to raise awareness of AMC and avoid extensive surgery.Colonoscopy image showing a large umbilicated subepithelial lesion seen in the cecum.Approximately 3x9 cm Gross Specimen from Appendectomy and Partial Cecectomy.Medium and high power magnification of the lining of the appendix showing a simple columnar mucinous epithelium and scattered goblet cells.Disclosures:Kriti Suwal indicated no relevant financial relationships. Neeraj Mangla indicated no relevant financial relationships. Michael Georgetson indicated no relevant financial relationships.

P0610 (S1732). Solitary Rectal Ulcer Syndrome: Neither Solitary, nor Ulcerated, a Misnomer Indeed 1388823 Nimish Thakral Memorial Healthcare System Solitary Rectal Ulcer Syndrome: Neither Solitary, nor Ulcerated, a Misnomer Indeed Colon ePoster Session Nimish Thakral, MD, Howard Baikovitz, MD; Memorial Healthcare System, Pembroke Pines, FLIntroduction: Solitary rectal syndrome is an enigmatic medical condition first described by 1829 when Cruveiher reported four cases of unusual rectal ulcers.The exact prevalence of this condition is not known due to its rarity, but has been estimated to be around 1 in 100,000.Patients characteristically present with rectal bleeding, passage of mucous, perineal or rectal pain, tenesmus, incomplete evacuation, straining on defecation and rectal prolapse.The condition presents with polypoid lesions in 44 %, ulcerations in 29% and edematous, non-ulcerated hyperemic mucosa in 27%. As such, Solitary Rectal Ulcer is a misnomer because the lesion is neither solitary nor ulcerated in the majority of cases.Case Description/Methods: We highlight two elusive cases with solitary rectal ulcer syndrome. The first patient is a 54-year-old HIV positive male who presented with tenesmus and rectal bleeding. On further evaluation he was found to have proctitis, rectal mucosal hyperemia with a whitish exudate on endoscopy which lead to an initial diagnosis of Lymphogranuloma Venerum. Failure of prolonged antibiotic treatment prompted further investigation which showed a histopathological picture of Solitary rectal ulcer syndrome. Patient continued to have symptoms despite multiple medical treatment modalities. Partial control of the patient’s symptoms was achieved post low anterior resection and ileostomy with later reversal.The second patient is a 63-year-old male who presented with weight loss and microscopic hematuria who on digital rectal examination had rectal induration. A CT scan done for further evaluation revealed pre-sacral and peri-rectal soft tissue thickening. A subsequent colonoscopy showed a 1.5 cm triangular rectal ulcer,with edematous and erythematous edges, at approximately 8 cm from the anal verge. Pathology results were consistent with solitary rectal ulcer syndrome. The patient’s course was complicated by the development of recurrent peri–rectal abscesses requiring surgical intervention and prolonged antibiotic therapy. Patient then went on to develop superimposed Clostridium difficle colitis.Discussion: Solitary rectal ulcer syndrome is a rare and benign syndrome with an extremely varied presentation that can prompt an easy misdiagnosis of malignancy, infection or inflammatory bowel disease. Treatment is not well defined and most cases eventually require surgical intervention. A high degree of suspicion is required to avoid an easy misdiagnosis with resultant prolonged morbidity.Patient 1: Polypoidal inflammation with whitish surface exudate.Patient 2: Triangular area of ulceration, 8 mm proximal to the anal verge.Histopathology showing smooth muscle proliferation in lamina propria with surface ulceration and chronic inflammatory infiltrate.Disclosures:Nimish Thakral indicated no relevant financial relationships. Howard Baikovitz indicated no relevant financial relationships.

P0620 (S1742). Not as It Appears: A Case of Amelanotic Anorectal Melanoma 1388757 Jaclyn Fackler Parkview Medical Center Not as It Appears: A Case of Amelanotic Anorectal Melanoma Colon ePoster Session Jaclyn Fackler, DO1, Charles Ruzkowski, MD1, Daniel Ortolano, MD2; 1Parkview Medical Center, Pueblo, CO; 2Conemaugh Memorial Medical Center, Johnstown, PAIntroduction: Primary anorectal melanoma (ARM) is a rare entity with anorectal presentation accounting for 0.4- 1.6% of all primary melanomas. ARM has an incidence of 0.5-4% of all anorectal malignancies. It presents after the fifth decade of life with nonspecific complaints. In patients taken for colonoscopy, diagnosis and resection can be difficult as lesions may be amelanotic and spread along submucosal planes. With incidence increasing, it is especially important to recognize ARM as a source of morbidity and mortality. Case Description/Methods: Our patient is an 89 yo female with Non-Hodgkin lymphoma presenting with left lower quadrant abdominal pain. Her pain was associated with loose stools and hematochezia attributed to hemorrhoids. The patient endorsed colonoscopy 10 years ago and had no polyps identified on any prior studies. Her labs demonstrated WBC of 71, Hgb of 12 with CT A&P demonstrating thickening and fat stranding at the rectum and splenic flexure. Physical exam was notable for tenderness on palpation of the LLQ, and rectal exam demonstrated a palpable mass proximal to the anal verge. The patient was taken for flexible sigmoidoscopy.Sigmoidoscopy demonstrated a non-bleeding malignant appearing 5 cm mass within the rectum which was non-circumferential, just above the dentate line, with multiple cold forceps biopsies taken. Pathology returned as suspicious for malignant melanoma with sections demonstrating an epithelioid malignancy with scattered pigmented cells. This sample was sent for further evaluation, and demonstrated a subepithelial proliferation of poorly differentiated malignant cells in a sheet like configuration. The nuclei displayed severe pleomorphism and the cytoplasm was granular and eosinophilic with questionable, focal pigmentation. By immunohistochemistry, tumor cells showed Mart-1 and CD31 coexpression with focal S-100 staining. The results were thought to represent a poorly-differentiated malignant melanoma. These findings were discussed with the patient, and it was determined she had a poor prognosis with no option for aggressive treatment. Patient did elect for hospice.Discussion: ARM carries a poor prognosis. This is due to misdiagnosis as hemorrhoids, polyps and other rectal cancer. At the time of diagnosis only 37% of ARM is confined at the anorectal area. Surgical resection is the mainstay of treatment for those with local disease. As ARM spread along submucosal planes and are often beyond complete resection, early recognition of ARM is of the utmost importance. Rectal massRectal massDisclosures:Jaclyn Fackler indicated no relevant financial relationships. Charles Ruzkowski indicated no relevant financial relationships. Daniel Ortolano indicated no relevant financial relationships.

P0630 (S1752). A Rare Case of Rectal Leiomyoma 1388850 Sami Ghazaleh University of Toledo Medical Center A Rare Case of Rectal Leiomyoma Colon ePoster Session Sami Ghazaleh, MD1, Christian Nehme, MD1, Azizullah Beran, MD1, Mohammed T. Awad, MD1, Dipen Patel, MD, MBA1, Sachit Sharma, MD1, Taha Sheikh, MD1, Muhannad Heif, MD2; 1University of Toledo Medical Center, Toledo, OH; 2ProMedica Toledo Hospital, Sylvania, OHIntroduction: Leiomyomas are benign tumors that originate from smooth muscles. The most common location is the uterus where they are referred to as uterine fibroids. We report a rare case of rectal leiomyoma that was identified during a screening colonoscopy.Case Description/Methods: A 54-year-old female patient was referred to the gastroenterology clinic by her primary care physician for a screening colonoscopy. She had never had a colonoscopy and was asymptomatic at the time of evaluation. Past medical history was significant for essential hypertension, gastroesophageal reflux disease (GERD), depression, and morbid obesity. Past surgical history was significant for appendectomy at the age of 11. Home medications included losartan 50 mg daily and metoprolol tartrate 25 mg twice daily. Family history was negative for gastrointestinal (GI) disorders. She drank alcohol socially and had never smoked or used illicit drugs.Screening colonoscopy revealed 2 semi-pedunculated polyps in the sigmoid colon and 5 sessile polyps in the transverse colon. The polyps were 5 to 12 mm in size. The polyps were removed with a hot snare and retrieved successfully without complications. Biopsies of the polyps were consistent with tubular adenomas and hyperplastic polyps. Digital rectal exam revealed a 2 cm smooth rectal mass palpated 4 to 5 cm from the anal verge.Computed tomography (CT) of the abdomen and pelvis was done to evaluate the rectal mass. It revealed a 4.6 cm soft tissue mass right to the rectum. Magnetic resonance imaging (MRI) showed a 3.5 x 3.8 x 5.2 cm smooth well-circumscribed mass external to the levator ani adjacent to the right rectum and right vagina with central necrosis. This was followed by endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) biopsy, which showed normal muscle tissue consistent with leiomyoma. The patient is currently scheduled to undergo surgical resection of the rectal mass.Discussion: Rectal leiomyomas are rare entities that can present with intestinal obstruction, bleeding, or perforation. They can also be asymptomatic and discovered incidentally by imaging or endoscopy. Although they can be diagnosed with EUS-guided FNA, surgical resection is required to differentiate this benign condition from the malignant leiomyosarcoma.MRI of the pelvis showing the rectal massColonoscopy showing the rectal massEndoscopic ultrasound (EUS) showing the rectal massDisclosures:Sami Ghazaleh indicated no relevant financial relationships. Christian Nehme indicated no relevant financial relationships. Azizullah Beran indicated no relevant financial relationships. Mohammed Awad indicated no relevant financial relationships. Dipen Patel indicated no relevant financial relationships. Sachit Sharma indicated no relevant financial relationships. Taha Sheikh indicated no relevant financial relationships. Muhannad Heif indicated no relevant financial relationships.

P0640 (S1762). An Atypical Presentation of Fulminant Clostridioides difficile Colitis Without Diarrhea 1389584 Urian Kim Mount Sinai Beth Israel Hospital An Atypical Presentation of Fulminant Clostridioides difficile Colitis Without Diarrhea Colon ePoster Session Urian T. Kim, MD, Yingheng Liu, MD, Steven Rogers, MD; Mount Sinai Beth Israel Hospital, New York, NYIntroduction: Clostridioides difficile infection (CDI) occurs mostly after antibiotics use and presents almost invariably with watery diarrhea. Here, we described an unusual presentation of fulminant CDI in a middle aged woman who was admitted with altered mental status and ileus but no diarrhea.Case Description/Methods: A 62-year-old woman with a history of schizophrenia was admitted to inpatient psychiatry for treatment of schizophrenia. On hospital day 47, she was found to be severely somnolent with fecal incontinence. Vital signs were notable for tachycardia and fevers. Physical exam was remarkable for abdominal distension, tympany with hypoactive bowel sounds, and diffuse abdominal tenderness. Laboratory revealed marked leukocytosis of white blood cells (WBC) 51 x 109 cells/L, lactate 3.66 mg/dL, and acute kidney injury with creatinine 1.4 mg/dL. Abdomen and pelvis CT showed proctocolitis and distension of rectum and left colon along with significant stool burden. The patient was initially started on broad spectrum antibiotics for severe sepsis of unknown origin however without significant improvement. She was managed for constipation with oral bowel regimen, tap water enemas, suppositories, and manual disimpactions. Given persistent leukocytosis and overflow diarrhea, stool C. difficile toxin was checked and resulted positive. The patient was subsequently treated for fulminant CDI with oral vancomycin, vancomycin enemas and intravenous metronidazole. After the 14-day course of antibiotics, her abdominal pain and distension resolved and leukocyte count normalizedDiscussion: The most common symptom of CDI is watery diarrhea which is often associated with abdominal pain, fever, and leukocytosis. Unique features in our case include lack of diarrhea, a significantly high WBC count and no history of recent antibiotics use. The abdominal pain and distention were attributed to stool impaction. Persistent high WBC, minimal response to bowel regimen, and ileus led to further investigation with C. difficile stool test in our patient. Symptoms resolved after proper treatment of CDI. It was reported that CDI can present acutely as ileus with constipation and absence of diarrhea [1]. This is due to pooling of secretions in dilated and atonic colon. These patients are at high risk to progress rapidly to toxic megacolon and perforation if not treated promptly. CDI should be considered in the context of unexplained severe sepsis with high WBC even without diarrhea.Disclosures:Urian Kim indicated no relevant financial relationships. Yingheng Liu indicated no relevant financial relationships. Steven Rogers indicated no relevant financial relationships.

P0650 (S1772). Diarrhea So Bad It Makes Your Tongue Swell 1387929 John Herndon University of Alabama Diarrhea So Bad It Makes Your Tongue Swell Colon ePoster Session John S. Herndon, MD1, Kirk Russ, MD1, Sameer Al Diffalha, MD2; 1University of Alabama, Birmingham, AL; 2UAB, Birmingham, ALIntroduction: We present a case of a common clinical problem encountered by gastroenterologists (chronic diarrhea) with a rare underlying etiology. This case highlights the importance of avoiding anchoring on negative test results and considering alternative diagnoses when there is a lack of improvement with empiric therapy and/or new signs or symptoms that arise.Case Description/Methods: A 70-year-old male with prostate cancer treated with radiation therapy was admitted with postprandial abdominal pain, distention, and intermittent nonbloody diarrhea for several months. Vital signs were normal. On physical exam, abdomen was soft, nontender, and mildly distended. CBC with differential, CMP, and lipase were normal. Stool culture was negative for Giardia and C. difficile. Contrasted CT abdomen & pelvis showed partial small bowel obstruction with multifocal areas of thickened small bowel and colon (Figure 1). With conservative management, partial small bowel obstruction resolved. Colonoscopy with poor bowel prep was notable for radiation proctitis. EGD with gastric and duodenal biopsies was unremarkable. Repeat colonoscopy again showed radiation proctitis and an area of erythematous mucosa in the sigmoid colon (Figure 2) with unremarkable biopsies. Empiric trials of steroids (for possible Crohn’s disease) and two courses of antibiotics (for small intestinal bacterial overgrowth) failed to improve symptoms. Surgical small intestinal biopsy was considered, but due to frustration he was lost to GI follow up. He continued to see his PCP and began to complain of tongue swelling, raising concern for amyloidosis. Tongue biopsy and later bone marrow biopsy were performed. Both were negative for amyloidosis and malignancy. Congo red staining was then performed on previous gastric and colon biopsies with positive result (Figure 3). Mass spectrometry confirmed AL amyloidosis. The patient underwent autologous stem cell transplant and remains disease free for > 2 years follow up.Discussion: GI amyloidosis is uncommon but can present with GI bleeding, malabsorption, protein losing enteropathy, and/or GI dysmotility. If suspicion is high, Congo red staining should be requested. Treatment is autologous hematopoietic cell transplant or chemotherapy. This case illustrates the importance of considering alternative diagnoses when findings remain unexplained, there is lack of improvement with empiric therapy, and/or new signs or symptoms arise. Negative biopsies do not always = normal.Contrasted CT Abdomen/Pelvis with small bowel thickening (arrows)Erythematous mucosa in sigmoid colonHematoxylin and Eosin stained section shows a submucosal thickening with associated amorphous pink material deposits. B-C show small blood vessels with abnormal wall thickening. D. Congo red special satin under polarized light showing the amyloid depositing in the blood vessels with its characteristic “apple green” birefringence.Disclosures:John Herndon indicated no relevant financial relationships. Kirk Russ indicated no relevant financial relationships. Sameer Al Diffalha indicated no relevant financial relationships.

P0660 (S1782). IgG4 Colitis and Infliximab Therapy 1388658 Ann Abraham University of Maryland Medical Center IgG4 Colitis and Infliximab Therapy Colon ePoster Session Ann A. Abraham, MD1, Atiye Aktay, MD1, James Moore, MD2, Samra Blanchard, MD1, Runa Watkins, MD1; 1University of Maryland Medical Center, Baltimore, MD; 2University of Maryland, Baltimore, MDIntroduction: Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory condition. It is characterized by increased serum levels of IgG4 and tissue infiltration by IgG4 cells. It can involve multiple organs and if untreated the disease can lead to fibrosis and irreversible organ damage. IgG4-RD has mostly been described in adults and it's exact prevalence in pediatrics is unknown. We report a pediatric case of IgG4-positive sclerosing colitis who had dramatic response to Infliximab therapy. Case Description/Methods: 6 year old adopted male who was previously healthy presented to ER with acute onset of severe abdominal pain and fever. He was febrile with severe RLQ tenderness, guarding and minimal bowel sounds. Labs showed elevated WBC and CRP. US abdomen study did not visualize appendix. Subsequent MRI abdomen showed descending colitis with no evidence of obstruction, abscess or acute appendicitis. He soon developed abdominal distension and multiple episodes of bilious emesis. AXR obtained showed dilated loops of small bowel concerning for partial SBO, requiring NGT decompression. Stool studies including C. Diff returned negative. As he developed a SIRS picture with worsening abdominal distension, stat CT abdomen obtained showed bowel dilation without an obvious transition zone or pneumatosis but thickening of terminal ileum and left colon. Due to patient's worsening clinical picture, there was concern for possible compromised bowel or distal bowel obstruction not diagnosed by imaging, hence he underwent diagnostic ex-laparoscopy which showed thickening and inflammation of the left colon leading to segmental left colon resection and descending colostomy. Biopsies were taken and immunostaining was concerning for an IgG4 sclerosis colitis. Serum IgG4 level was elevated at 202. Patient was started on steroids followed by Infliximab as maintenance therapy. Repeat EGD/Colonoscopy prior to colostomy reversal showed normal biopsies and immunostaining. He responded well to Infliximab therapy with subsequent normal serum IgG4 levels. Discussion: The pathogenesis of IgG4-RD remains incompletely understood. Study shows that small subset of patients with IBD can be characterized by high levels of serum and mucosal IgG4. These patients are generally prone to more severe and extensive lesions suggesting that high level of IgG4 may be a biomarker for a new subtype of IBD. The current literature in this area is sparse. Our case showed positive response to Infliximab therapy in IgG4 positive colitis.Disclosures:Ann Abraham indicated no relevant financial relationships. Atiye Aktay indicated no relevant financial relationships. James Moore indicated no relevant financial relationships. Samra Blanchard indicated no relevant financial relationships. Runa Watkins indicated no relevant financial relationships.

P0670 (S1792). A Case of Descending Colon Volvulus Following Sigmoid Volvulus Status Post Sigmoidectomy 1388431 Jeremy Van Rush University Medical Center A Case of Descending Colon Volvulus Following Sigmoid Volvulus Status Post Sigmoidectomy Colon ePoster Session Jeremy Van, DO, Ioannis Economou, MD; Rush University Medical Center, Chicago, ILIntroduction: Colonic Volvulus is the 3rd leading cause of colonic obstruction worldwide behind carcinoma and diverticulitis. The sigmoid colon and cecum are the most common locations. This case describes a patient with prior sigmoid volvulus (SV) and sigmoidectomy (SDY) presenting with descending colon volvulus (DCV). There have only been a few reports of DCV and to our knowledge no case in someone with a prior SV s/p SDY.Case Description/Methods: A 75-yo male with past medical history (hx) of SV s/p SDY with colo-colonic anastomosis after failed detorsion, chronic constipation, and hypothyroidism presented with a 4-day hx of abdominal pain and obstipation. No hx of opiate use. K+ 3.9 and TSH 1.021. Abdominal x-ray showed dilated loops of large bowel with concern for distal obstruction. On CT Abdomen and Pelvis (CT A/P) with IV contrast, there was diffuse large bowel dilatation up to the sigmoid colon with no mass or wall thickening visualized. Colonoscopy showed a patent anastomosis, spiraling of the descending colon and viable mucosa. Successful detorsion was performed.Discussion: Volvulus is the torsion of a colonic segment over its mesenteric axis. DCV is a rare entity. The descending colon is a retroperitoneal structure usually without a mesentery. However, the primitive dorsal mesocolon may fail to fuse with the parietal peritoneum in the 4th-5th month of gestation, resulting in persistent descending mesocolon. Abdominal X-ray can show a grossly dilated ahaustral colonic loop without air in the rectum. CT A/P can show “coffee bean” sign with a large twisted loop of bowel, “whirl” sign with twisting of the mesentery and its vessels, “X marks the spot” sign with crossing loops of bowel at the site of transition, and “split wall” sign with mesenteric fat indenting. Typical CT imaging features may be absent in 1/4th of all patients. On colonoscopy, there is usually a spiral, sphincter-like area of mucosa and viability of mucosa can be assessed. Gentle pressure and insufflation are carried out for reduction. Recurrence rate after detorsion is around 85%. The incidence of recurrent volvulus after previous resection and anastomosis is around 6-36%. As this patient is at high risk for recurrence after detorsion, subtotal colectomy will be completed.Chen A, Yang FS, Shih SL, et al. CT Diagnosis of Volvulus of the Descending Colon with Persistent Mesocolon. 2003 April. 1003-1006.Booij KA, Tanis PJ, van Gulik TM, et al. Recurrent volvulus of the transverse colon after sigmoid resection. 2009 April. 471–472.Markedly dilated gas-filled loops of large bowel concerning for distal obstructionAxial view-> Markedly dilated transverse and descending colonA: coronal view-> Significant distension of the descending colon without any obvious colonic wall mass or thickening with abrupt narrowing distally B: Sagittal view-> Significant distension of the descending colonDisclosures:Jeremy Van indicated no relevant financial relationships. Ioannis Economou indicated no relevant financial relationships.

P0680 (S1802). Colononic Schistosomiasis 1390732 Jose Debes University of Minnesota Colononic Schistosomiasis Colon ePoster Session Yohannes Birhanu, MD1, Mesfin Asefa, MD1, Amir Sultan, MD1, Jose Debes, MD2; 1Addis Ababa University, Addis Ababa, Adis Abeba, Ethiopia; 2University of Minnesota, Minneapolis, MNIntroduction: Schistosoma infection is endemic to certain tropical areas with water beds. It usually affects the liver or the bladder (depending on the species). We present a rather unique case of Schistosoma affecting the colon.Case Description/Methods: A 19 years old male presented to a hospital in Addis Ababa (Ethiopia) with an 8-month history of recurrent abdominal pain and occasional blood in the stool. Tenesmus and loss of appetite were present but there was no significant weight loss. Physical and basic laboratory exams, including liver enzymes, were unremarkable. Stool exam was positive for blood but negative for ova and parasite. Abdominal ultrasonography was normal. A colonoscopy was performed with a working diagnosis of inflammatory bowel disease (IBD). The exam showed a patchy mucosal erythema with scattered nodularity and multiple vascular lesions in ascending colon, sigmoid and rectum. Colon biopsies showed multiple schistosoma eggs with surrounding eosinophilic inflammation. It was noted that the patient resides in Bahir Dar, a lakeside city in Northern Ethiopia endemic for schistosomiasis. Upon inquiring, the patient reported frequent swimming in the lake and washing clothes in the river.The patient was treated with Praziquantel 40mg/Kg one dose orally and reported complete resolution of symptoms during a clinic visit 2 weeks later.Discussion: Schistosomiasis is a common helminth-related disease that frequently affects the liver or bladder depending on the species. Colonic schistosomiasis occurs as eggs migrate through the intestinal wall, provoking mucosal granulomatous inflammation. Lesions that occur in rectum and sigmoid are usually secondary to S. Mansoni. Suspicion of Schistosoma colitis is often low, despite a reported association between colonic schistosomiasis and colon cancer. Biopsies specifically aimed at the mucosal alterations are important as they will provide higher yield for egg identification. In our case, the presentation and demographics of the patient were compatible with IBD and this was the main suspected diagnosis. In individuals originating from endemic areas infection such as Schistosoma should be clearly ruled out, as initiation of immunosuppressive regimens upon suspicion of IBD can be detrimental.Disclosures:Yohannes Birhanu indicated no relevant financial relationships. Mesfin Asefa indicated no relevant financial relationships. Amir Sultan indicated no relevant financial relationships. Jose Debes indicated no relevant financial relationships.

P0690 (S1812). A Solitary Sigmoid Perineurioma in an Otherwise Healthy 30-Year-Old Male 1388323 Sara Kamionkowski MetroHealth Medical Center A Solitary Sigmoid Perineurioma in an Otherwise Healthy 30-Year-Old Male Colon ePoster Session Sara Kamionkowski, DO, Abdulfatah Issak, MD, Claire Zhang, MD, Annette Kyprianou, MD; MetroHealth Medical Center, Cleveland, OHIntroduction: Colorectal perineuriomas are rare benign fibroblastic polyps of the colon that comprise only 0.1% to 0.46% of polyps found on colonoscopy and usually present as a sessile polyp distal to the splenic flexure. We report a case of sessile sigmoid perineurioma in a young healthy male.Case Description/Methods: A 30-year-old male with chronic constipation presented for a diagnostic colonoscopy. He suffered severe constipation despite the use of over the counter laxatives. Family history was significant for a paternal uncle who was diagnosed with colon cancer at age 40. The patient underwent colonoscopy at our gastroenterology clinic and was found to have a 3-4 mm sessile polyp in the sigmoid colon (Fig 1). The rectum showed a 3 x 3 cm patch with biopsy results significant for fragments of an ulcer, believed to be from chronic constipation. The pathology report of the sigmoid polyp showed a perineurioma. Histology showed a poorly circumscribed proliferation of uniform, spindled cells in the lamina with eosinophilic cytoplasm with absence of ganglion cells, pleomorphism, mitotic figures and necrosis (Fig 2). Immunohistochemical staining was negative for S100 (Figure 3), ruling out Schwann cell hamartoma and ganglioneuroma.Discussion: Perineuriomas are peripheral nerve sheath tumors composed of bland spindle cells with ovoid nuclei in a whorling appearance. Nuclear pleomorphism, mitotic activity and necrosis are often absent. Immunohistochemistry is often strongly positive for Glucose Transporter -1 (GLUT-1), Claudin-1, and less specifically for Epithelial Membrane Antigen (EMA). BRAF V600E mutations are found in 63% of these polyps. Perineuriomas comprise 0.1% to 0.46% of colonic polyps and are often found incidentally in asymptomatic patients. They can appear pedunculated or serrated. If they are mucosal, the differential includes ganglioneuromas, schwannomas, neuromas, neurofibroma, or Schwann cell hamartomas; if submucosal, it may be schwannoma versus a gastrointestinal stromal tumor (GIST). GIST is important to rule out given its malignant potential, but they tend to be larger with an average size of 20 mm. Perineuriomas are often around 4 mm. GIST may show hyperchromasia and mitotic activity. There have not been any case control or cohort studies to assess the risk of malignant potential especially in polyps positive for BRAF V600E mutations. While these polyps are regarded as benign, it is prudent to rule out other tumors that have malignant potential.Figure 1: 4mm sessile polyp in sigmoid colonFigure 2: spindle cells in the lesion (arrow)Figure 3: Spindle cells negative for S100 stain (arrow)Disclosures:Sara Kamionkowski indicated no relevant financial relationships. Abdulfatah Issak indicated no relevant financial relationships. Claire Zhang indicated no relevant financial relationships. Annette Kyprianou indicated no relevant financial relationships.

P0700 (S1822). Recognition and Management of Pneumatosis Intestinalis: A Rare and Usually Benign Gastrointestinal Complication of Advanced Scleroderma 1389310 Sundus Mian State University of New York Upstate Medical University Recognition and Management of Pneumatosis Intestinalis: A Rare and Usually Benign Gastrointestinal Complication of Advanced Scleroderma Colon ePoster Session Sundus Mian, MD1, Hiba Bilal, DO1, Michelle Bernshteyn, MD2, Andras Perl, MD, PhD1; 1State University of New York Upstate Medical University, Syracuse, NY; 2SUNY Upstate Medical University, Syracuse, NYIntroduction: Scleroderma is a progressive autoimmune disorder that causes microvasculopathy and organ fibrosis leading to deformity and dysfunction. The gastrointestinal (GI) system is affected in up to 90% of patients. Vascular damage induces enteric neuropathy and myopathy which causes GI hypomotility and intestinal bacterial overgrowth. Upper GI manifestations include gastro-esophageal reflux disease (GERD), Barrett’s esophagus, and gastroparesis. Lower GI manifestations include small intestinal bacterial overgrowth (SIBO), pseudo-obstruction, malabsorption, and rarely pneumatosis intestinalis (PI) in advanced disease. Case Description/Methods: A 55-year-old woman with limited scleroderma (CREST syndrome) presents with three days of constipation, nausea, and vomiting. She suffered from CREST syndrome for 26 years with recent advancing skin, lung, and GI disease. Computed Tomography (CT) of the abdomen/pelvis demonstrated diffuse bowel distension with intramural gas-filled sacs without free air or fluid. Labs revealed normal white blood cell count and lactate. She lacked fever and abdominal tenderness. Conservative measures of bowel rest, serial abdominal exams, and monitoring for bowel movement were pursued. Rheumatology was consulted and felt her PI was a complication of advanced scleroderma. The patient was given one week of Metronidazole and Erythromycin and high flow nasal cannula (HFNC) oxygen therapy inpatient. She was discharged after constipation resolution.Discussion: About 85% of PI cases are secondary to other diseases such as scleroderma while 15% are idiopathic. Secondary PI follows a subacute, progressive course. PI typically involves the small and/or large intestine. It is associated with pseudo-obstruction and overgrowth of intestinal bacteria. CT abdomen/pelvis is the imaging of choice to identify the characteristic gas-filled cysts within the bowel wall which are thought to be due to bacterial invasion and gas production.Management involves ruling out life-threatening surgical emergencies such as bowel ischemia, perforation, or peritonitis. PI carries an overall estimated mortality of 20-25%. Afterward, PI is managed conservatively with bowel rest to relieve pseudo-obstruction, antibiotics such as Metronidazole to target SIBO, use of motility agents (i.e. Erythromycin, Metoclopramide, or Octreotide), and HFNC or hyperbaric oxygen therapy to resorb intramural gas. However, the efficacy of these therapies are controversial due to lack of substantial evidence.IMAGE 1 shows the axial view of the CT abdomen/pelvis without contrast which highlights dilated large bowel loops with Pneumatosis intestinalis in the wall of the ascending colon.IMAGE 2 shows the coronal view of the CT abdomen/pelvis without contrast which highlights dilated large bowel loops and Pneumatosis intestinalis in the wall of the ascending colon.Disclosures:Sundus Mian indicated no relevant financial relationships. Hiba Bilal indicated no relevant financial relationships. Michelle Bernshteyn indicated no relevant financial relationships. Andras Perl indicated no relevant financial relationships.

P0710 (S1832). Intestinal Spirochetosis in an Immunocompetent Patient Carrying a Diagnosis of Irritable Bowel Syndrome With Diarrhea (IBS-D) 1388350 Abdulfatah Issak MetroHealth Medical Center Intestinal Spirochetosis in an Immunocompetent Patient Carrying a Diagnosis of Irritable Bowel Syndrome With Diarrhea (IBS-D) Colon ePoster Session Sara Kamionkowski, DO, Abdulfatah Issak, MD, Jaclyn Jacobs, MD, Claire Zhang, MD, Nisheet Waghray, MD; MetroHealth Medical Center, Cleveland, OHIntroduction: Intestinal spirochetosis (IS) has been reported as a rare cause of diarrhea and abdominal pain with the prevalence of IS varying worldwide. We report a case of a patient with previously known IBS-D diagnosed with IS on colonic biopsies.Case Description/Methods: A 33-year-old male presented to gastroenterology clinic with chronic diarrhea for ten years. He reported four to ten daily episodes of watery diarrhea accompanied by peri-umbilical abdominal pain. Review of systems were negative otherwise. Initial laboratory work-up including gliadin IgA and IgG antibodies, stool culture, giardia, cryptosporidium, syphilis IgG/IgM, CRP, and ESR were normal. A trial of amitriptyline 25 mg QHS, as needed loperamide 2 mg and dicyclomine 20 mg with increased fiber supplementation was unsuccessful prompting colonoscopic evaluation, which revealed normal mucosa. Hematoxylin and eosin (H&E) stain of the random colonic biopsy specimens revealed dense, fingerlike basophilic bands on the epithelial surface of the large intestine (Figure 1). A diagnosis of intestinal spirochetosis was confirmed by Steiner silver stain (Figure 2). He was prescribed metronidazole 500 mg TID for ten days with resolution of his symptoms and remained asymptomatic in follow up nine months later.Discussion: Colonic spirochetes have a lower prevalence of 0.2% to 3.2% in developed countries, but a higher prevalence has been seen in Eastern Asian regions. Prevalence is higher among those with gastrointestinal complaints and among men who have sex with men (28% to 62.5%). Certain species of spirochetes have been found to be associated with symptomatic disease. Those with Brachyspira pilosicoli are more likely to have gastrointestinal symptoms whereas those colonized with B. aalborgi may be asymptomatic. Intestinal spirochetes are diagnosed on histopathology with H&E stain and confirmed with immunohistochemistry using Steiner or Dieterle silver stain. Mucosal findings on colonoscopy are non-specific or normal. IS is also reported to be associated with irritable bowel syndrome (IBS) and hyperplastic/adenomatous polyps. It is thought that spirochete colonization can lead to destruction of the microvilli, which is speculated to lead to symptomatic IS; however, the pathophysiology for symptomatic colonic disease is unknown. It is important to consider spirochetes as a cause of diarrhea in those who carry concurrent diagnosis of unrevealing chronic diarrhea and IBS-D. Treatment with metronidazole should be considered in symptomatic patients.Figure 1: H&E stain of colonic biopsyFigure 2: Steiner Silver stain of colonic biopsyDisclosures:Sara Kamionkowski indicated no relevant financial relationships. Abdulfatah Issak indicated no relevant financial relationships. Jaclyn Jacobs indicated no relevant financial relationships. Claire Zhang indicated no relevant financial relationships. Nisheet Waghray indicated no relevant financial relationships.

P0790 (S1838). Cutting into Colorectal Cancer Prevention: Development of Lymph Node Metastasis Despite Clear Margins 1389790 Dale Zachary Gozum A.T. Still University Cutting into Colorectal Cancer Prevention: Development of Lymph Node Metastasis Despite Clear Margins Colorectal Cancer Prevention ePoster Session Dale Zachary Gozum, MS1, Neilinder Behniwal, MD2, Vivek Mittal, MD3; 1A.T. Still University, Fresno, CA; 2Saint Agnes Hospital, Fresno, CA; 3St. Agnes Medical Center, Fresno, CAIntroduction: Colorectal cancer (CRC) is the 2nd leading cause of cancer related death within the US despite progressively declining mortality. Advancements in screening guidelines and colonoscopy techniques led to higher adenoma detection rate and increased malignant polyp resection. Although complete resection of malignant polyps with clear margins prevents recurrence, patients are not guaranteed to be CRC risk free. Cancer may be found in the polypectomy site or lymph nodes (LNs). Here we present a case of a polypectomy with clear margins in the sigmoid colon and later findings of metastatic disease to the LNs.Case Description/Methods: A 45 y.o. male with a PMH of HTN presented to the outpatient gastroenterologist (GI) office with rectal bleeding for one month. He reported multiple bright red formed stools. FHx was relevant only for his father with h/o benign colon polyps. Colonoscopy 3 weeks later revealed a 50 mm pedunculated polyp in the sigmoid colon. Hot snare excisional polypectomy was performed and the area was tattooed. Histopathology revealed an intact well-differentiated adenocarcinoma invading into the stalk of the tubulovillous adenoma. Stalk margin was negative for invasive carcinoma by 3mm and staged PT1,pNX with no lymphovascular invasion. Extra vigilance by the patient led to a colorectal surgery follow up. After evaluation, sigmoid colon resection with LN dissection was done. Although no residual adenocarcinoma was identified, 1 of 13 LNs dissected was positive of metastatic adenocarcinoma. The patient was discharged with a 3 month follow up with GI. He underwent chemoradiation and a repeat PET scan at 1 year which was negative for residual disease. Repeat colonoscopy at 1 and 3 years was negative for recurrence.Discussion: Colonoscopy remains the gold standard for detecting and treating polyps. Several studies support demonstrating clear margins to show entire adenoma removal on histopathological examination. Resections >1 mm of free margins show 0-2% recurrence while < 1 mm demonstrate 21-33%. Ideally, samples should have >2 mm of free margins but recurrence chances are not 0%. Therefore, individual decisions should be made for discussing possible LN metastasis which inevitably cause recurrence despite complete polyp resection.Close surveillance with oncology and colorectal surgery should be considered in large malignant polyps.50mm rectosigmoid polyp with stalk.Polypectomy with 3mm cancer free margin.Lymph node with metastatic adenocarcinoma.Disclosures:Dale Zachary Gozum indicated no relevant financial relationships. Neilinder Behniwal indicated no relevant financial relationships. Vivek Mittal indicated no relevant financial relationships.

P0800 (S1848). Breaking Bad: Device Failure During Endoscopic Full Thickness Resection Salvaged by Snare 1388533 Shista Priyadarshini Guthrie/Robert Packer Hospital Breaking Bad: Device Failure During Endoscopic Full Thickness Resection Salvaged by Snare Endoscopy Video Forum ePoster Session Sub-Category: Clinical Vignettes/Case ReportsShista Priyadarshini, MD1, Moamen Gabr, MD, MSc2; 1Guthrie/Robert Packer Hospital, Sayre, PA; 2University of Kentucky, Lexington, KYIntroduction: The full-thickness resection device (FTRD) is a novel endoscopic device used for the resection of non-lifting and partially resected colorectal lesions. There are no standardized guidelines for management of cases of FTRD failure. We describe a case of FTRD failure during Endoscopic Full Thickness Resection (eFTR) of a non-lifting adenoma after device deployment that was successfully managed by snare cautery. It highlights scenario of the FTRD failure and the subsequent steps taken to salvage the procedure.Case Description/Methods: A 65 years old Caucasian male presented for evaluation of incomplete resection of a polyp that did not lift during Endoscopic Mucosal Resection (EMR) at another facility. Pathology from the partially resected lesion revealed sessile serrated adenoma (SSA). The patient was scheduled for colonoscopy with possible eFTR. On colonoscopy, a 15 mm sessile polyp was found in the distal ascending colon consistent with the non-lifting portion of the previously resected SSA. Preparations were made for endoscopic full thickness resection using the FTRD system. The lesion was grasped with endoscopic graspers and was noted to fit into the test cap. The borders of the polyp were outlined with marking probe. A second colonoscope pre-loaded with the FTRD system was inserted. The lesion was targeted with grasping forceps and pulled into the cap; the over scope clip was deployed and the integrated snare was used to perform endoscopic resection. Cautery was applied during snare closure; however, the snare broke during resection (Figure 1). The colonoscope with the FTRD was removed and reinserted after disconnecting the system. The lesion was grasped using a 15 mm braided snare above the over scope clip and was then successfully resected with all the cautery markings noted within the resected lesion(Figure 2). The patient was observed in the post-operative unit and discharged same day with no complications.Discussion: The Colonic FTRD system is an effective method for resection of partially resected and non-lifting lesions that cannot be removed by EMR. However, device failure can be an issue rendering the procedure unsuccessful. This video shows a 15 mm braided snare cautery can be successfully used in case of FTRD failure. Of note, pathology of the resected lesion was Sessile Serrated Adenoma with no dysplasia. Since the current literature is evolving on this topic, this abstract aims to provide growing evidence on treatment guidelines on FTRD failure even after successful deployment.Figure 1: Snare Break PointFigure 2: Resected sessile polypDisclosures:Shista Priyadarshini indicated no relevant financial relationships. Moamen Gabr indicated no relevant financial relationships.

P0810 (S1858). Treatment of Squamous Dysplasia Using Hybrid Argon Plasma Coagulation 1387928 Jose Nieto Borland Groover Clinic Treatment of Squamous Dysplasia Using Hybrid Argon Plasma Coagulation Endoscopy Video Forum ePoster Session Sub-Category: Clinical Vignettes/Case ReportsAmeya A. Deshmukh, BA1, Enad Dawod, MD2, Ahmed M. Elmeligui, MBBCh, MD3, Javier Tejedor-Tejada, MD4, Jose Nieto, DO, FACG5; 1Midwestern University - CCOM, Downers Grove, IL; 2New York-Presbyterian/Weill Cornell Medical Center, New York City, NY; 3Kasr Alainy Hospital / Cairo University, Cairo, Al Jizah, Egypt; 4Hospital Universitario Rio Hortega, Valladolid, Castilla y Leon, Spain; 5Borland Groover Clinic, Jacksonville, FLIntroduction: Hybrid argon plasma coagulation (APC) is a novel non-contact ablative procedure providing an increase in efficacy over standard argon plasma coagulation (APC). Standard APC was originally utilized in the ablation of Barrett’s esophagus but also included risks of stricture formation, perforation, bleeding and fever. We show the usefulness of hybrid APC in the ablation of squamous cell dysplasia expanding upon the current uses for this therapy modality. The introduction of hybrid APC allows the injection of a high-pressure water stream underneath the mucosa elevating the esophageal epithelium. This elevation doubles as a safety cushion but also enable a more thorough ablation of dysplastic tissue with no increase in adverse events. Additionally, this allows a larger area of the esophagus to be ablated in one session than standard APC therapy. Hybrid APC is a more technically difficult procedure than standard APC therapy but a skilled endoscopist with previous APC experience should be able to overcome the slight learning curve.Case Description/Methods: A 76-year old female with a past medical history of GERD with esophagitis presented with severe patchy mucosal changes characterized by nodularity spanning the entire esophagus found using narrow band imaging. Biopsies were also taken at 25 cm, 27 cm, 29 cm, 30 cm, 31 cm, 33 cm, 35 cm. At each mucosal site, the epithelium was elevated by an endoscopic injection using a high-pressure water jet of saline and subsequently ablated. This process was repeated at each mucosal site containing squamous dysplasia. Minimal bleeding occurred throughout the procedure. Hemostasis was achieved through the use hybrid APC. Patient was told to undergo repeat upper endoscopy for further treatment pending the biopsy pathology results.Discussion: Despite a slightly increased learning curve over standard APC, hybrid APC stands to be an improvement over the former. Direct comparison of both techniques in an ex vivo study using pig esophagi displayed that Hybrid APC decreased coagulation depth by 50% compared to standard APC. This reduction in depth spares the proper muscle layer from thermal injury likely leading to a decrease in strictures. The procedure still carries some risk of post-operative fever, bleeding, perforation and strictures but at a lower rate when compare to standard APC treatment. Overall, Hybrid APC provides a more efficacious and safer method of ablation over standard APC therapy due to the mucosal saline injection prior to ablation.Narrow band imaging visualizing dysplasia throughout the esophagus prior to the lower esophageal sphincter (LES).Ablation of dysplastic epithelium in the middle third of the esophagus.Endoscopic view of the esophagus post-ablation.Disclosures:Ameya Deshmukh indicated no relevant financial relationships. Enad Dawod indicated no relevant financial relationships. Ahmed Elmeligui indicated no relevant financial relationships. Javier Tejedor-Tejada indicated no relevant financial relationships. Jose Nieto: Boston Scientific – Consultant. ERBE – Consultant.

P0820 (S1868). EUS-Guided Splenic Abscess Management With a Lumen Apposing Metal Stent (LAMS) 1388422 Jose Nieto Borland Groover Clinic EUS-Guided Splenic Abscess Management With a Lumen Apposing Metal Stent (LAMS) Endoscopy Video Forum ePoster Session Sub-Category: Clinical Vignettes/Case ReportsAhmed M. Elmeligui, MBBCh, MD1, Ameya A. Deshmukh, BA2, Javier Tejedor-Tejada, MD3, Enad Dawod, MD4, Jose Nieto, DO, FACG5; 1Kasr Alainy Hospital / Cairo University, Cairo, Al Jizah, Egypt; 2Midwestern University - CCOM, Downers Grove, IL; 3Hospital Universitario Rio Hortega, Valladolid, Castilla y Leon, Spain; 4New York-Presbyterian/Weill Cornell Medical Center, New York City, NY; 5Borland Groover Clinic, Jacksonville, FLIntroduction: Splenic abscess is an uncommon clinical infection with an estimated incidence of 0.5%. Hematogenous spread from another infected area in the body is the most common source of splenic abscess. While in some cases, a pancreatic abscess and diverticulitis may sometimes extend and involve the spleen. The diagnosis of this condition can be easily missed resulting in a very high mortality reaching more than 70%. Nevertheless, the mortality can be reduced to less than 1% with proper treatment. EUS-guided drainage of splenic abscess using lumen apposing metal stent (LAMS) is an emerging alternative novel procedure appropriate for patients who cannot tolerate surgery.Case Description/Methods: A 44-year-old male presented with a syncopal episode with a past medical history significant for hypertension and necrotizing pancreatitis. During a prior admission for abdominal pain 3 months ago, he developed pancreatic necrosis during an ERCP and subsequently underwent pseudocyst drainage. He continued to experience similar abdominal pain from this previous admission. CT of the abdomen revealed a gastric drainage catheter extending into a complex splenic collection with soft tissue stranding and fluid tracking throughout the abdomen.A cystogastrostomy approach for abscess drainage was chosen due to the close proximity of the stomach wall and abscess. A 10 x 10 mm LAMS was utilized due to the large size of the abscess and to avoid buried stent syndrome that can occur with double pigtail stents.First, the endoscope was advanced into the stomach and the splenic abscess was visualized. Then, under EUS-guidance, one 10 x 10 mm LAMS was deployed with cautery enhancement into the abscess cavity through the stomach wall. Once deployment of the LAMS was complete, the pyogenic contents were drained into the stomach. Follow up CT scan was performed one-month post procedure and revealed complete splenic abscess resolution.Discussion: EUS-guided splenic abscess drainage is a safe and effective therapeutic alternative to CT-guided percutaneous drainage and surgery. It allows for greater spatial visualization and awareness of anatomical structures aiding in the placement of stents. In clinical practice, EUS-guided splenic drainage is shown to have a higher success rate with fewer complications compared to percutaneous drainage and surgery. EUS-guided drainage has also been successfully performed on other conditions involving pancreatic pseudocysts, hepatic abscesses, pelvic abscesses, and subphrenic abscesses.EUS visualization of the splenic abscess measuring 5.9 cm x 6.9 cm.EUS visualization of the distal flange of LAMS deployment into the abscess cavity.CT scan displaying complete drainage of the splenic abscess after LAMS deployment.Disclosures:Ahmed Elmeligui indicated no relevant financial relationships. Ameya Deshmukh indicated no relevant financial relationships. Javier Tejedor-Tejada indicated no relevant financial relationships. Enad Dawod indicated no relevant financial relationships. Jose Nieto: Boston Scientific – Consultant. ERBE – Consultant.

P0930 (S1879). Dysphagia and Odynophagia: Rare Initial Manifestations of Diffuse Large B-Cell Lymphoma 1389422 Kati Choi Baylor College of Medicine Dysphagia and Odynophagia: Rare Initial Manifestations of Diffuse Large B-Cell Lymphoma Esophagus ePoster Session Kati Choi, MD, Reka Szigeti, MD, PhD, Milena Gould, MD; Baylor College of Medicine, Houston, TXIntroduction: Diffuse large B cell lymphoma (DLBCL) can involve extranodal sites including the gastrointestinal (GI) tract, reportedly occurring in up to 30% of patients. In the GI tract, stomach is the most commonly affected organ.Case Description/Methods: A 68-year-old non-obese, immunocompetent male with no history of tobacco and alcohol use presented with six months of progressively worsening solid food dysphagia, odynophagia, and 30 pounds unintentional weight loss. He also mentioned subjective fevers without chills or night sweats. CT imaging showed a 4.4 cm esophageal mass with hilar, mediastinal, supraclavicular, abdominal, iliac, and inguinal lymphadenopathy. Upper endoscopy visualized a circumferential, ulcerated mass from middle to distal esophagus, and a patch of erythematous mucosa in the proximal gastric body. Biopsies of the esophageal mass and abnormal gastric mucosa revealed high grade diffuse large B cell lymphoma with Ki67 proliferative index of >95%, and without evidence of Epstein-Barr Virus. Subsequent FISH studies did not report rearrangements in BCL-2, BCL-6 or MYC. He received 5 cycles of chemotherapy regimen that consisted of rituximab, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (R-EPOCH) with excellent treatment response based on subsequent CT imaging that showed significant decrease in size of thoracic, abdominal and pelvic lymphadenopathy.Discussion: With only a handful of cases reported in the literature, esophagus is an infrequent site of extranodal lymphoma. And for esophageal symptoms of dysphagia and odynophagia to be the initial manifestations leading to the diagnosis of DLBCL is rare. Given the widespread lymphadenopathy noted on imaging, we suspect that our patient’s site of origin of DLBCL was in the lymph nodes with a rare secondary spread to the esophagus and stomach, rather than primary DLBCL of the GI tract. Aside from adding to the sparse cases described in the literature, this case highlights the importance of keeping a broad differential diagnosis for esophageal mass particularly in patients who do not have the classic risk factors for esophageal adenocarcinoma and squamous cell carcinoma.CT chest showed a 4.4 cm esophageal mass with bilateral hilar, mediastinal and left supraclavicular lymphadenopathy, and bilateral pulmonary nodules consistent with metastasis.Upper endoscopy visualized a circumferential, ulcerated mass from middle to distal esophagus.Biopsies of the esophageal mass and abnormal gastric mucosa revealed a diffuse infiltrate of large, atypical lymphoid-appearing cells surrounded by a large area of necrosis (A) with stains positive for MUM-1 (B) and BCL-6 (C), consistent with high grade diffuse large B cell lymphoma.Disclosures:Kati Choi indicated no relevant financial relationships. Reka Szigeti indicated no relevant financial relationships. Milena Gould indicated no relevant financial relationships.

P0940 (S1889). Esophageal Lichen Planus – An Additional Diagnosis in the Differential Requiring Additional Stains 1389775 David Braun Methodist Dallas Medical Center Esophageal Lichen Planus – An Additional Diagnosis in the Differential Requiring Additional Stains Esophagus ePoster Session David S. Braun, MD, Elizabeth John, MD, Paul R. Tarnasky, MD; Methodist Dallas Medical Center, Dallas, TXIntroduction: Lichen planus (LP) is a chronic inflammatory condition that commonly affects the skin and mucous membranes with an estimated incidence of 0.5% to 2%. While the most frequent sites of involvement are the mouth, genitalia, scalp, and nails, reports of lichen planus with esophageal involvement (ELP) in the literature remain scant.Case Description/Methods: An 86-year old female with a past medical history of hypothyroidism, sarcoidosis, and oral ulcers was evaluated for a four year history of dysphagia to solids and liquids and 30 pound weight loss. Gastrointestinal review of systems was otherwise negative except for recent recurrence of oral ulcers. The patient underwent a barium esophagram, which revealed a tortuous stricture involving 3 cm of the cervical esophagus. A subsequent esophagogastroduodenoscopy (EGD) was performed, revealing several rings and few plaques along the proximal esophagus (Figure 1). The stricture (Figure 2) was difficult to traverse but was successfully dilated to 12 mm. Biopsies of the proximal esophagus were initially unremarkable with histology revealing benign esophageal squamous mucosa with mild reactive changes. With the history of oral ulcers and sarcoidosis, additional immunohistochemical stains were added. Further analysis revealed positive fibrin deposition consistent with lichenoid inflammation, concerning for ELP. The patient was started on oral budesonide and serial dilations up to 16 mm were performed, which resulted in some improvement of symptoms.Discussion: While cutaneous and oral findings of LP are easily detectable, ELP remains a diagnostic challenge. Given its rarity and resemblance to other esophageal pathologies such as eosinophilic esophagitis, reflux esophagitis, and candida esophagitis, accurate diagnosis requires additional stains to make a diagnosis. The mean time to diagnosis is around five years, and often after multiple endoscopies and dilations. Given the scarcity of ELP, treatment is based on anecdotal reports, and usually consists of oral steroids with dilation. Furthermore, given the risk of malignant transformation to squamous cell carcinoma, patients should be carefully followed though there are no surveillance guidelines as the diagnosis is rare. This case highlights the importance of accurate and timely diagnosis with additional stains in patients presenting with progressive dysphagia to provide adequate treatment and malignancy surveillance.Figure 1. Endoscopic view of the proximal esophagus revealing several proximal rings and few plaques.Figure 2. Endoscopic view of the severe tortuous stricture in the proximal esophagus.Disclosures:David Braun indicated no relevant financial relationships. Elizabeth John indicated no relevant financial relationships. Paul Tarnasky indicated no relevant financial relationships.

P0950 (S1899). Impaction Distraction: Boerhaave Syndrome Due to Schatzki Ring Mediated Food Impaction 1388264 Kathryn Driggers Walter Reed National Military Medical Center Impaction Distraction: Boerhaave Syndrome Due to Schatzki Ring Mediated Food Impaction Esophagus ePoster Session Kathryn Driggers, MD, Zachary C. Junga, MD, James Brunswick, MD, Adam Tritsch, MD; Walter Reed National Military Medical Center, Bethesda, MDIntroduction: While dysphagia is common in adults in the United States (prevalence 1 in 25 adults), and food impaction necessitating esophagogastroduodenoscopy (EGD) is much less common (incidence 13 per 100,000); complete obstruction with inability to manage secretions is a gastrointestinal emergency. Boerhaave syndrome, or spontaneous esophageal perforation due to severe vomiting or straining, is an infrequent complication described in isolated cases. We describe a case of Schatzki ring-induced dysphagia and food impaction with subsequent esophageal perforation secondary to an episode of vomiting. This was successfully managed non-operatively.Case Description/Methods: A 70 year-old male with solid non-progressive dysphagia for several years presented with a food impaction from steak. After several hours, a bout of forceful retching led to chest pain and hematemesis. A computed tomography (CT) scan of the chest demonstrated no evidence of perforation so an EGD was undertaken which showed a possible mucosal defect with adherent blood clot. The EGD was aborted and the patient was transferred to a hospital with overnight cardiothoracic surgery. A repeat CT scan demonstrated a small, contained esophageal perforation which was managed conservatively with broad-spectrum antibiotics and a proton pump inhibitor (PPI). The patient did well and was discharged without issue. Three months later, repeat EGD demonstrated normal esophageal mucosa, mild gastric antral gastropathy, and a moderately obstructing Schatzki ring at the gastroesophageal junction. This was partially disrupted with cold forceps but not dilated given lack of dysphagia symptoms after initiation of a PPI.Discussion: Boerhaave Syndrome is rare, accounting for 15% of esophageal perforations, however it’s mortality rate approaches 30% due to delayed diagnosis. Although mediated by vomiting/straining, it is an incredibly rare complication of food impaction due to a Schatzki ring. Boerhaave Syndrome can be managed conservatively if it is identified early (< 24 hours), there are minimal signs of sepsis, the perforation is contained, and close observation by an expert esophageal team is possible. If not, esophageal ruptures require definitive surgical management. This case illustrates successful conservative management of Boerhaave syndrome in the setting of food impaction due to a Schatzki ring. This is the second case of esophageal rupture due to a Schatzki ring ever reported.Figure 1: Management of Esophageal PerforationsImage 1: EGD on presentation. maroon blood in the mid esophagus with large obstructing clotImage 2: EGD at 3 months. moderately obstructing Schatzki's ring at the gastroesophageal junctionDisclosures:Kathryn Driggers indicated no relevant financial relationships. Zachary Junga indicated no relevant financial relationships. James Brunswick indicated no relevant financial relationships. Adam Tritsch indicated no relevant financial relationships.

P0960 (S1909). Black Esophagus: A Syndrome of Acute Esophageal Necrosis 1389046 Muhammad Yousaf MedStar Union Memorial Hospital Black Esophagus: A Syndrome of Acute Esophageal Necrosis Esophagus ePoster Session Muhammad N. Yousaf, MD1, Anees Siddiqi, MD2, Nahar Saleh, MD3, Fizah Chaudhary, MD1, Rehan Farooqi, MD2; 1MedStar Union Memorial Hospital, Towson, MD; 2MedStar Union Memorial Hospital, Baltimore, MD; 3MedStar Union Memorial Hospital, Batlimore, MDIntroduction: Black esophagus, also known as acute esophageal necrosis (AEN) syndrome is a rare entity characterized by patchy or diffuse circumferential black pigmentation of esophageal mucosa from ischemic necrosis and may present with life threatening upper gastrointestinal hemorrhage (UGIH) resulting in high mortality in immunocompromised patients.Case Description/Methods: A 56-year-old female with diabetes mellitus (DM), gastroesophageal reflux disease (GERD), and alcohol abuse (8-10 drinks daily) presented with multiple episodes of coffee ground emesis and epigastric abdominal pain for two days. The pain was sharp epigastric, 10/10 in severity, non-radiating, precipitated with ingestion of oral intake, without alleviating factors. On examination, she was tachycardic (120/minute) and hypotensive (80/50 mm of Hg), had oropharyngeal erythema with white spots on its posterior wall, and significant ptyalism. She had epigastric tenderness and unremarkable digital rectal examination. Laboratory workup revealed lactic acidosis ( >15 mmol/L), acute kidney injury with creatinine 2.21 mg/dL, leukocytosis (18 k/dL), and transaminitis. A computed tomography (CT) of abdomen and pelvis without contrast was unremarkable. The hospital course was complicated by hematemesis, dysphagia, and melena. After initial resuscitation, esophagogastroduodenoscopy (EGD) was performed which revealed inflammation of the epiglottis, arytenoid cartilages, and dark mucosal pigmentation of distal 2/3 of the esophagus with associated hiatus hernia (figure 1). A biopsy of esophageal mucosa demonstrated fragments of fibrinopurulent exudate and necrotic tissue with pigment deposition (figure 2). Evidence of helicobacter pylori, cytomegalovirus, herpes simplex virus, candida albicans infections, and malignancy was not found on further testing. She was managed with strict NPO, total parenteral nutrition, proton pump inhibitors, and analgesics. Serial EGDs showed complete resolution of the lesion in 4 weeks and was transitioned to an oral diet.Discussion: In this case, vascularity of the distal esophagus was compromised due to uncontrolled DM, GERD, and binge alcohol drinking, complicated with acute UGIH due to mucosal tears from persistent vomiting. Acute UGIH is alarming for AEN in patients with multiple co-morbidities and a high index of clinical suspicion is required for pursuing EGD for early diagnosis. Early recognition and aggressive resuscitation are the fundamental principles for the management of AEN and better outcome of the disease.Figure 1. Distal two-thirds of the esophagus showing black pigmentation of mucosa due to ischemic necrosis.Figure 2. A biopsy of esophageal mucosa demonstrating fragments of fibrinopurulent exudate and necrotic tissue with pigment deposition (arrow).Disclosures:Muhammad Yousaf indicated no relevant financial relationships. Anees Siddiqi indicated no relevant financial relationships. Nahar Saleh indicated no relevant financial relationships. Fizah Chaudhary indicated no relevant financial relationships. Rehan Farooqi indicated no relevant financial relationships.

P0970 (S1919). Acute Esophageal Obstruction: A Unique Case of a Thrombus Impaction 1389905 Tiago Martins Baystate Medical Center Acute Esophageal Obstruction: A Unique Case of a Thrombus Impaction Esophagus ePoster Session Tiago Martins, DO, Nicolas Cal, DO, Yesenia Greeff, MD; Baystate Medical Center, Springfield, MAIntroduction: Esophageal obstruction is a common gastrointestinal emergency generally caused by foreign objects in children and by food in adults. There are no prior reports in the medical literature of an esophageal obstruction caused by a large thrombus. We present a case that demonstrates a unique cause of esophageal obstruction in order to help clinicians broaden their differential in such a case.Case Description/Methods: A 71-year-old male with coronary artery disease, atrial fibrillation on apixaban, and insulin-dependent diabetes presented to the emergency department with right upper quadrant pain. He was found to have acute cholecystitis and given his comorbidities he was successfully treated with percutaneous cholecystostomy tube placement. On the day of planned discharge the patient began to experience sudden onset dysphagia with coffee-ground emesis. His dysphagia progressed in a matter of hours to the point that he was spitting up his secretions, raising suspicion for an esophageal obstruction.A few hours later he developed frank hematemesis associated with tachycardia which prompted an emergent upper endoscopy. Exam showed a large distal esophageal thrombus obliterating the lumen. No active bleeding was noted. The gastroscope was used to apply forward gentle pressure to the right aspect of the thrombus. This intervention was unsuccessful. Next, using a 3 x 5.5-cm RescueNet™ retrieval net the large thrombus was grasped and successfully extracted. The thrombus measured 9 x 2-cm. Inspection of the underlying esophageal mucosa revealed Grade D erosive esophagitis. His severe esophagitis was treated with omeprazole 40 mg twice daily for 8 weeks. The patient was able to tolerate oral intake following this endoscopic intervention and he was discharged home the following day, after admitting to his providers a long history of intermittent dysphagia to solids. Repeat upper endoscopy to check for esophageal healing and outpatient high resolution esophageal manometry are planned for further work up of an underlying motility disorder pending lifting of pandemic-related scheduling restrictions.Discussion: We believe this is first case of acute esophageal obstruction by large impacted thrombus. In addition, this case potentially demonstrates two pathologies, esophagitis and suspected dysmotility, resulting in a unique presentation. Clinicians must keep a broad differential for patients who develop esophageal obstruction without discrete food bolus ingestion.Image 1: Tubular shaped, distal esophageal thrombus impacting the distal esophagus.Image 2: Portion of the thrombus removed.Image 3: Distal esophagus with Grade D erosive esophagitisDisclosures:Tiago Martins indicated no relevant financial relationships. Nicolas Cal indicated no relevant financial relationships. Yesenia Greeff indicated no relevant financial relationships.

P0980 (S1929). A Case Series of Eosinophilic Esophagitis Associated With Primary Adrenal Insufficiency 1389433 Joshua Kwon Mayo Clinic A Case Series of Eosinophilic Esophagitis Associated With Primary Adrenal Insufficiency Esophagus ePoster Session Joshua Y. Kwon, MD, Andree Koop, MD, Dawn Francis, MD; Mayo Clinic, Jacksonville, FLIntroduction: Eosinophilic esophagitis (EoE) is associated with the development of secondary adrenal insufficiency in patients treated with topical corticosteroids; however, the association with primary adrenal insufficiency is not reported in the literature. In this study, our aim was to review patients with primary adrenal insufficiency and a diagnosis of EoE and describe their disease characteristics and treatments.Case Description/Methods: We reviewed cases at Mayo Clinic Florida with the diagnosis of both EoE and primary adrenal insufficiency. Information gathered included sex, age at diagnosis, symptoms, white blood cell and eosinophil count, endoscopic and histological findings, EoE endoscopic reference score, and treatment including medical and procedural therapies.Three cases were identified and reviewed in the electronic medical record. The average age at diagnosis was 25.3 years, and two patients were female. Patients B and C were siblings with primary adrenal insufficiency associated with polyglandular autoimmune syndrome type 1, an inherited autoimmune disorder with multi-system effects including primary adrenal insufficiency and chronic mucocutaneous candidiasis. Both exhibited evidence of esophageal candidiasis. All patients presented with dysphagia and globus sensation, and one had peripheral eosinophilia (patient B). Despite esophageal symptoms, one patient had normal endoscopic findings with characteristic findings of eosinophils on histology. The other two patients had characteristic mucosal changes of EoE including ringed and small-caliber esophagus with areas of stenosis. Their endoscopic reference scores were 3 and 5. All patients were treated with omeprazole 40mg twice daily, one patient with inhaled fluticasone 220mcg twice daily, and one with oral budesonide 3mg twice daily. One patient underwent dilation of an esophageal stricture.Discussion: Primary adrenal insufficiency has been associated with peripheral eosinophilia, seen in one of our study patients. Two patients were siblings with an inherited autoimmune disorder. All patients had characteristic symptoms of eosinophilic esophagitis and evidence of eosinophilia on histology, and responded to treatment with a proton pump inhibitor or topical steroid. For patients with primary adrenal insufficiency, young age, and symptoms of dysphagia, eosinophilic esophagitis should be considered as an etiology of symptoms. Further studies are needed to determine the pathogenesis and implications of this association.Patient characteristicsDisclosures:Joshua Kwon indicated no relevant financial relationships. Andree Koop indicated no relevant financial relationships. Dawn Francis indicated no relevant financial relationships.

P1000 (S1949). The Utilization of Bethanechol in Myotonic Dystrophy Patients With Oropharyngeal Dysphagia and Esophageal Dysmotility 1389183 Mackenzie Jarvis CHS Digestive Health The Utilization of Bethanechol in Myotonic Dystrophy Patients With Oropharyngeal Dysphagia and Esophageal Dysmotility Esophagus ePoster Session Award: Presidential Poster AwardMackenzie Jarvis, MPAM, PA-C, DMSc1, Jason Baker, PhD2, Elyse R. Thakur, PhD3, Dawn Vickers, RN1, Baharak Moshiree, MD, MSc4; 1CHS Digestive Health, Charlotte, NC; 2University of North Carolina, Charlotte, NC; 3CHS Digestive Health (Atrium Health) and Baylor College of Medicine, Charlotte, NC; 4Atrium Health, University of North Carolina, Charlotte, NCIntroduction: Myotonic Dystrophies (MD) are a complex group of progressive myopathic disorders with multiple gastrointestinal symptoms due to global muscle weakness, including upper esophageal motor dysfunction. Patients with MD often have difficulty initiating swallows leading to oropharyngeal dysphagia and are at risk of nasopharyngeal regurgitation, pulmonary aspiration, pneumonia and malnutrition1, 2. Oropharyngeal dysphagia has been recognized as a medical disability with increased patient morbidity, health care utilization and mortality 3. Bethanechol is a cholinesterase inhibitor, muscarinic agonist used to treat patients with ineffective esophageal motility (IEM) disorder by increasing peristaltic amplitude in the smooth muscle of the esophagus 3. Bethanechol has been shown to significantly improve esophageal bolus transit propulsion in patients with severe IEM 4.Case Description/Methods: Three male patients with MD, mean age 42, age range 29-54, presented with symptoms of progressive dysphagia, globus sensation, coughing and choking with decreased oral intake as a result. All patients had testing including a barium swallow, EGD and High Resolution Esophageal Manometry (HREM). (See Figure 1) A hypotensive upper esophageal sphincter (UES) was present in 2/3 MD patients (mean pressure 14 mmHg. In the esophageal body, an IEM pattern was present in 1/3 patients with absent contractility in 2/3 MD patients. Impaired bolus clearance was present in all MD patients. All three MD patients were treated with Bethanechol, 25 mg t.i.d, crushed for 3 months. At their follow-up clinic visits, each patient was asked about their symptoms of dysphagia, coughing, globus sensation and choking. All three MD patients had resolution of each of these symptoms. None of the patients had aspiration subsequent to treatment with bethanechol and their weight remained stable.Discussion: Diagnosing esophageal dysmotility disorders in MD prevents complications such as aspiration pneumonia and malnutrition. UES and esophageal body muscle weakness is the predominant dysmotility seen in MD patients on HREM leading to oropharyngeal dysphagia5. The ineffective peristalsis that results in prolonged bolus transit time and abnormal esophageal clearance in MD patients can improve with pro-cholinergic drugs such as bethanechol4.Our small case series found improvement in the oropharyngeal dysphagia, regurgitation and choking symptoms with use of bethanechol.Disclosures:Mackenzie Jarvis: Allergan – Consultant, Speaker's Bureau. Salix Pharmaceuticals – Advisory Committee/Board Member, Consultant, Speaker's Bureau. The Gastroenterology & Hepatology Advanced Practice Providers (GHAPP) association – Advisory Committee/Board Member.Jason Baker indicated no relevant financial relationships. Elyse Thakur indicated no relevant financial relationships. Dawn Vickers indicated no relevant financial relationships. Baharak Moshiree indicated no relevant financial relationships.

P1010 (S1959). A Case of Intramural Esophageal Hematoma With Associated Hemothorax 1388655 Aaron Weiss Westchester Medical Center at New York Medical College A Case of Intramural Esophageal Hematoma With Associated Hemothorax Esophagus ePoster Session Aaron Weiss, MD1, Zilan Lin, MD2, Frederick Yick, MD3, Shireen Pais, MD4; 1New York Medical College Westchester Medical Center, Bronx, NY; 2Westchester Medical Center, White Plains, NY; 3New York Medical College Westchester Medical Center, Valhalla, NY; 4Westchester Medical Center at New York Medical College, Valhalla, NYIntroduction: Intramural esophageal hematoma can occur spontaneously or following trauma. We report a rare case of a patient discovered to have an obstructing intramural esophageal hematoma with associated hemothorax following an unrelated surgical procedure.Case Description/Methods: An 86-year-old woman with a past medical history of peripheral arterial disease was admitted for acute lower extremity ischemia and underwent successful thrombectomy. Other than several unsuccessful nasogastric tube (NGT) placement attempts, her operative course had been uneventful, and she was being continued on a heparin infusion post-operatively. On postoperative day 1, she was noted to have epigastric pain, multiple episodes of vomiting with scant bloody emesis and difficulty tolerating oral intake. She had no significant prior gastrointestinal (GI) history. A computed tomography angiogram (CTA) revealed a small hiatal hernia with fluid within the esophagus to the level of the upper thorax. The GI service was consulted and a bedside esophagogastroduodenoscopy (EGD) was performed and revealed a dilated proximal esophagus with a large intramural esophageal hematoma. The EGD scope could not traverse the hematoma safely and the decision was made to further evaluate the esophagus with noninvasive imaging. An esophagram demonstrated contrast material within the proximal esophagus and a concomitant CT scan of the chest revealed a new left hemothorax, which required chest tube placement. The patient was brought to the endoscopy suite the following day for a second EGD. The intramural hematoma was again noted and an NGT was successfully advanced into the duodenum under endoscopic and fluoroscopic guidance. The patient was managed conservatively with supportive care and broad-spectrum antibiotics and remained stable. A repeat esophagram 8 days later showed transit of contrast material into the stomach, without any contrast extravasation. The patient continued to recover, tolerating a full diet with resumption of her anti-coagulation.Discussion: Intramural esophageal hematoma is an uncommon finding on upper endoscopy. Although not initially expected, our patient had a classic presentation with pain, inability to tolerate oral intake and small volume hematemesis. Furthermore, she had an associated hemothorax, which while exceedingly rare, has been described. Although the etiology in our case remains unclear, it may be multi-factorial, related to ongoing anticoagulation, retching, and/or trauma from preceding nasogastric tube placement.Endoscopic view of esophageal intramural hematoma obstructing the lumen.Contrast CT scan showing esophageal hematoma with associated hemorrhagic effusion.Disclosures:Aaron Weiss indicated no relevant financial relationships. Zilan Lin indicated no relevant financial relationships. Frederick Yick indicated no relevant financial relationships. Shireen Pais indicated no relevant financial relationships.

P1020 (S1969). Esophageal Ectopic Sebaceous Glands: An Unusual Finding in a Patient With Gastroesophageal Reflux Disease 1388288 Firas Bahdi Baylor College of Medicine Esophageal Ectopic Sebaceous Glands: An Unusual Finding in a Patient With Gastroesophageal Reflux Disease Esophagus ePoster Session Firas Bahdi, MD, Suneal Agarwal, MD, FACG; Baylor College of Medicine, Houston, TXIntroduction: The Esophageal Ectopic Sebaceous Glands (EESG) are a rare benign condition with an estimated incidence of 0.0046% and a mean age of diagnosis of 50 years with 1:1 male-to-female ratio. It is unclear whether EESG result from a congenital anomaly during the embryonic layers’ separation or a metaplastic response to post-pubertal triggers given absence of any reported pediatric case. EESG can be a challenging diagnosis given macroscopic broad differential. We here present a case of EESG in a patient with GERD and discuss EESG’s clinical and endoscopic characteristics.Case Description/Methods: A 63 year old white female with GERD, controlled with aggressive lifestyle interventions and high dose proton pump inhibitors, underwent her first upper endoscopy to screen for Barrett's esophagus, which revealed numerous non-scrapable small yellowish plaques involving the middle and lower third of the esophagus diffusely (Figures A-B). The histopathological examination of the esophageal biopsies using hematoxylin and eosin stains revealed stratified squamous epithelium with multiple lobulated sebaceous glands without hair follicles in the lamina propria consistent with esophageal ectopic sebaceous glands (Figure C). There was no evidence of intestinal metaplasia, candida, or viral cytopathic effect. The patient was counseled about this benign finding and no changes were made to her established management plan.Discussion: Approximately two thirds of patients with EESG experience associated reflux or dyspepsia symptoms, while the remaining third of cases are incidentally diagnosed on upper endoscopy for alternative screening indications. The relationship between the EESG and GERD or its severity remains unclear. Endoscopically, EESG usually manifest as non-scrapable small yellowish plaques involving the middle and lower third of the esophagus, ranging in size from 1 to 20 millimeters and in number from one to over a hundred lesions. EESG are often macroscopically misdiagnosed for candidiasis, xanthomas, squamous papillomas, or glycogen acanthoses. Accurate diagnosis was more likely to be made by endoscopists who are motivated to seek a tissue biopsy as histopathological examination is key to accurate diagnosis. EESG are a rare benign condition that does not necessitate specific treatment or endoscopic follow up as it does not carry any malignant potential.Figure AFigure BFigure CDisclosures:Firas Bahdi indicated no relevant financial relationships. Suneal Agarwal indicated no relevant financial relationships.

P1030 (S1979). Holding Pressure: The Use of a Sengstaken-Blakemore Tube in the Setting of Atrioesophageal Fistula Hemorrhage 1389384 Megan Lewis University of Texas Health Science Center Holding Pressure: The Use of a Sengstaken-Blakemore Tube in the Setting of Atrioesophageal Fistula Hemorrhage Esophagus ePoster Session Award: Presidential Poster AwardMegan Lewis, DO1, Brenda M. Briones, MD2, Tamneet Singh, MD1, Patrick Snyder, MD1; 1University of Texas Health Science Center, San Antonio, TX; 2UT Health San Antonio, San Antonio, TXIntroduction: The Sengstaken-Blakemore tube (SBT) was originally introduced in the 1950s as a temporizing measure for the management of variceal bleeding. We present a case in which a SBT was employed unconventionally to temporize severe hemorrhage secondary to an atrioesophageal fistula (AEF).Case Description/Methods: A 56-year-old man with a medical history of atrial fibrillation and radiofrequency ablation two weeks prior presented with acute onset fever, left sided weakness, nausea and non-bloody emesis. On arrival he was febrile to 105.5 F, tachycardic, hypotensive and altered. He was intubated for airway protection, started on pressors and sepsis protocol and was given emergent tPA for suspicion of stroke. CT head was negative for hemorrhagic or ischemic stroke but showed pneumocephalus (Figure 1). A few hours later, he developed large volume hematochezia. Due to his hemodynamic compromise and the uncertainty of underlying cirrhosis, an acute upper gastrointestinal bleed with possible varices was suspected. A SBT was placed urgently with resultant improvement in hemodynamics and reduced frequency of bloody bowel movements. Blood cultures were positive for multiple oral organisms. This result, in conjunction with the finding of pneumocephalus on head imaging and a recent history of atrial ablation, raised concern for an AEF. Endoscopy was deferred, and a CT chest was obtained showing air in the esophageal wall and edema around the descending aorta and left atrium (Figure 2). Unfortunately, the patient developed multi-organ failure and was deemed too sick for surgery. He ultimately succumbed to his multiple medical complications.Discussion: AEF is a rare complication of cardiac ablation and carries a high mortality rate of 40-100%. It occurs most frequently 1-4 weeks after the ablation. The condition most commonly presents with fever, focal neurologic symptoms, chest pain, dysphagia and/or hematemesis. A high index of suspicion for AEF in the setting of recent cardiac ablation and the appropriate clinical presentation is essential, as endoscopy with air insufflation is contraindicated due to the risk of air embolism. The diagnosis is confirmed on cross sectional imaging. Patients with AEF should be referred for immediate surgical intervention. This case highlights the potential utility of a SBT to apply esophageal tamponade in patients with AEF until definitive intervention can be performed.Figure 1. Pneumocephalus noted on CT headFigure 2. Paraesophageal air noted on CT chestFigure 3. Table representing the most relevant laboratory values from admission, after GIB episode and one-day after presentation. Patient received 6 units of crash blood after episode of GI bleed.Disclosures:Megan Lewis indicated no relevant financial relationships. Brenda Briones indicated no relevant financial relationships. Tamneet Singh indicated no relevant financial relationships. Patrick Snyder indicated no relevant financial relationships.

P1040 (S1989). A Search for a Turkey Bone Uncovers an Eagle 1387995 Dane Johnson University of Alabama A Search for a Turkey Bone Uncovers an Eagle Esophagus ePoster Session Dane Johnson, MD, Kirk Russ, MD; University of Alabama, Birmingham, ALIntroduction: Eagle syndrome, also known as stylohyoid syndrome, is the elongation of the styloid process or calcification of the stylohyoid ligament leading to otalgia, dysphagia, or globus sensation.Case Description/Methods: A 65-year-old male with GERD was seen in consultation in the ED for two days of dysphagia and concern for esophageal foreign body. He reported swallowing a turkey bone and subsequently developed a persistent globus sensation and pain localizing to the right side of neck just above the sternal notch. Review of electronic medical record revealed prior workup for dysphagia including: unremarkable CT of the head and neck, and EGD with normal esophageal biopsies and empiric dilation without relief of symptoms. Physical examination in the emergency department did not reveal any abnormality in the posterior oropharynx, cervical lymphadenopathy, or crepitus. Plain radiograph interpretation in the ED raised concern for possible foreign body in the hypopharynx (Arrow, FIGURE 1). Subsequent review of plain radiographs and prior CT by radiology revealed bilateral calcification of stylohyoid ligaments, right greater than left, consistent with a diagnosis of Eagle Syndrome. EGD was deferred, patient was discharged home, and Otolaryngology was consulted for outpatient evaluation.Discussion: Eagle syndrome was first described by Watt W. Eagle in 1937. The prevalence of has been reported as 3.3%, but only 4-10% of patients develop symptoms. The pathophysiology is unclear. Preceding head and neck trauma may be a risk factor, however, this history is lacking in most patients with Eagle syndrome. In a review of 61 cases of Eagle syndrome by Ceylan et al, the most common symptoms included odynophagia (85.2%), otalgia (77%), globus sensation (60.6%), cervical pain (57.3%), and facial pain (36%). Diagnosis is made based on clinical symptoms and radiographic confirmation of ossified stylohyoid ligament. Plain radiographs are usually sufficient to confirm Eagle Syndrome, although CT of the neck can be used to further characterize the anatomy and rule out other causes of dysphagia. Eagle syndrome can be managed conservatively with analgesics and local steroid injections but definitive treatment is surgical. Case reports of Eagle syndrome are uncommon in the gastroenterology literature. As gastroenterologists are commonly consulted to evaluate dysphagia, odynophagia, and globus sensation it is important to be familiar with Eagle syndrome and its management.Calcified stylohyoid ligament shown on lateral radiographDisclosures:Dane Johnson indicated no relevant financial relationships. Kirk Russ indicated no relevant financial relationships.

P1050 (S1999). Endoscopic Management of Mesh Erosion Following Hiatal Hernia Surgical Revision 1389060 John Brown University of Kentucky Endoscopic Management of Mesh Erosion Following Hiatal Hernia Surgical Revision Esophagus ePoster Session John A. Brown, MD1, Houssam Mardini, MD, FACG2; 1University of Kentucky, Lexingtion, KY; 2University of Kentucky, Lexington, KYIntroduction: Hiatal hernia surgical repair may involve the use of biosynthetic absorbable (bioresorbable) mesh. This mesh can erode over time particularly following revisional surgery. Less invasive methods for management with the use of endoscopy should be considered when possible.Case Description/Methods: A 58 year old female with history of hiatal hernia status post remote Toupet fundoplication and subsequent revision with takedown and performance of Collis gastroplasty with Nissen fundoplication and use of biosynthetic absorbable mesh approximately ten months prior presented with epigastric abdominal pain, dysphagia, nausea and 10 pound weight loss over one month period. Patient underwent upper endoscopy at outside facility and was noted to have what appeared to be eroded mesh in the esophagus near the gastroesophageal junction. This could not be completely removed with biopsy forceps. CT scan showed evident surgical mesh with no obvious perforation or leak. Following transfer to our facility, upper endoscopy was repeated which was notable for penetrating mesh 36 cm from incisors. A fistula was noted at this site following removal of mesh with rat toothed forceps. A 20 mm x 12 cm Taewoong partially covered controlled-release stent with 25 mm flange was placed in the esophagus. A 12 French nasojejunal feeding tube was placed. The patient was made NPO for 48 hours with tube feeding as initial primary means of nutrition. Patient was then started on clear liquid diet and advanced to pureed diet with good tolerance. The nasojejunal tube was removed. A repeat EGD was performed four weeks following with removal of stent. The fistula had decreased in size, however further mesh erosion was noted. The decision was made to replace esophageal stent and patient was scheduled for outpatient follow up for consideration of additional intervention. Discussion: Endoscopic management of eroded bioresorbable mesh following hiatal hernia surgical repair should be considered prior to repeat surgical intervention when possible. However, conservative management may not always be successful and multi-disciplinary collaboration is needed from the time of presentation.Erosion of biosynthetic absorbable mesh in the lower esophagus following revisional hiatal hernia surgery.Biosynthetic absorbable mesh pictured after removal.Placement of 20 mm x 12 cm Taewoong partially covered controlled-release stent with 25 mm flange following removal of eroded biosynthetic absorbable mesh in the esophagus with rat toothed forceps. A fistula is visualized near the gastroesophageal junction.Disclosures:John Brown indicated no relevant financial relationships. Houssam Mardini indicated no relevant financial relationships.

P1070 (S2019). A Rare Find: Mixed Adenoneuroendocrine Carcinoma of the Esophagus Presenting as Painless Jaundice 1388225 Gilles Hoilat SUNY Upstate Medical University A Rare Find: Mixed Adenoneuroendocrine Carcinoma of the Esophagus Presenting as Painless Jaundice Esophagus ePoster Session Gilles J. Hoilat, MBBS, Ceren Durer, MD, Seren Durer, MD, Basel Abuzuaiter, MBBS, Serenella Serinelli, MD, Amulya Penmetsa, MD; SUNY Upstate Medical University, Syracuse, NYIntroduction: Ninety-five percent of esophageal cancers are either adenocarcinomas and/or squamous cell carcinomas. Mixed adenoneuroendocrine carcinoma (MANEC) are rare, there have been reported cases of MANEC in other locations of the digestive tract, however, their location in the esophagus is very uncommon and unusual. Case Description/Methods: A 68-year-old male with no significant past medical history, presented to the ED when he was told by his partner that he looks “yellow” in color. The patient denies weight loss and abdominal symptoms. His review of systems was only positive for fatigue and exertional dyspnea. His physical exam was only positive for scleral icterus. His labs were significant for ALT: 268, AST: 301, ALP: 1409, Dbil: 12.6 and Tbil: 14.9. He underwent CT of the abdomen and pelvis showing enhancing masses throughout both hepatic lobes. The largest lesion measures approximately 9.1 x 7.6 cm. These lesions are causing some mass effect on the common duct with mild intrahepatic ductal dilatation. He was also found to have a large mass just distal to the gastroesophageal junction that measures approximately 4.3 x 2.8 x 5.7 cm. CT lung showed innumerable soft tissue nodules throughout both lungs that measure up to approximately 1.2 cm. The patient underwent PTC due to a high likelihood of narrow esophageal lumen and inability to pass the scope for ERCP with the placement of an internal/external biliary drain as well as IR guided liver biopsy with findings consistent with metastatic poorly differentiated large cell neuroendocrine carcinoma. He underwent 6 cycles of carboplatin and etoposide. CT scan done during and after chemotherapy showed a significant decrease in the size of the intrahepatic and intrapulmonary masses, however, the esophageal mass grew. Four months later patient started experiencing symptoms of dysphagia, EUS guided biopsy revealed mixed adeno-neuroendocrine carcinoma, and the patient was switched to a lifelong blenderized diet.Discussion: Most of the cases described in the literature are patients with stage 2-3 esophageal mass; they usually undergo surgical resection of the tumor because of the acuity of symptoms.Typically, patients exhibit gastrointestinal symptoms such as dysphagia, epigastric pain, dyspepsia which prompts them to come to the hospital. Our case is the first case in the literature that describes a very rare aggressive esophageal tumor metastasized to the liver and lungs with jaundice as the only presenting symptom.Partially Obstructing Friable Esophageal Mass In the Lower EsophagusCT Scan Showing Esophageal Mass and Enhancing Masses Throughout LiverA. Nests of malignant cells with peripherally palisaded nuclei are seen. B. Cells show abundant eosinophilic cytoplasm, low nuclear/cytoplasmic ratio, and nuclear pleomorphism with coarse chromatin and prominent nucleoli. Apoptotic bodies are seen (arrow).Disclosures:Gilles Hoilat indicated no relevant financial relationships. Ceren Durer indicated no relevant financial relationships. Seren Durer indicated no relevant financial relationships. Basel Abuzuaiter indicated no relevant financial relationships. Serenella Serinelli indicated no relevant financial relationships. Amulya Penmetsa indicated no relevant financial relationships.

P1080 (S2029). Proximal Esophageal Varices in the Absence of Superior Vena Cava Obstruction 1389560 Farah Deshmukh Bassett Medical Center Proximal Esophageal Varices in the Absence of Superior Vena Cava Obstruction Esophagus ePoster Session Farah Deshmukh, MD, Peter Francisco, MD; Bassett Medical Center, Cooperstown, NYIntroduction: Isolated proximal esophageal varices also known as “downhill” esophageal varices are an unusual finding with an incidence of approximately 0.4% to 10% of all acute esophageal variceal bleeds. They are generally associated with portal hypertension or superior vena cava obstruction due to mediastinal masses such as lung cancer, thymoma or lymphoma. Proximal esophageal varices are rarely seen in the absence of these etiologies.Case Description/Methods: An 87-year-old male with congestive heart failure and no history of liver disease or chronic alcohol use presented with acute lower gastrointestinal bleed. Gastrointestinal work up involved colonoscopy that showed diverticulosis and upper endoscopy that revealed non-bleeding grade I to II proximal esophageal varices. There was no evidence of distal esophageal varices, gastric varices or gastric antral vascular ectasia (GAVE). Computed tomography scan of the chest was done to assess for any vascular compromise that may explain the proximal esophageal varices, however, the scan was unremarkable and did not reveal any anatomical or vascular abnormalities. The patient was managed with close follow-up and repeat endoscopy was not recommended due to his advanced age.Discussion: The pathophysiology and management of proximal esophageal varices is different from distal esophageal varices. Superior vena cava obstruction secondary to a mediastinal mass accounts for approximately 30% of the cases of proximal esophageal varices and these can be managed with temporary banding, balloon angioplasty or surgical intervention. Isolate proximal esophageal varices in the absence of an underlying etiology are rarely seen and its management is thus not well studied.Disclosures:Farah Deshmukh indicated no relevant financial relationships. Peter Francisco indicated no relevant financial relationships.

P1090 (S2039). “Black Esophagus”: A Rare Complication of Diabetic Ketoacidosis 1388596 Sunny Sandhu University of California San Francisco Fresno “Black Esophagus”: A Rare Complication of Diabetic Ketoacidosis Esophagus ePoster Session Sunny Sandhu, MD1, Timothy Wang, MD1, Devang Prajapati, MD2; 1University of California San Francisco Fresno, Fresno, CA; 2University of California San Francisco Fresno / Vetarans Affairs Central California Health System, Fresno, CAIntroduction: Acute esophageal necrosis (AEN), also known as “black esophagus”, is a rare presentation of severe esophageal injury. Most cases occur in patients with cardiovascular comorbidities and alcohol use. Injury results from a combination of ischemic injury and gastroesophageal acid reflux-mediated mucosal damage. Hallmark endoscopic findings are a circumferential black mucosal discoloration which abruptly stops at the gastroesophageal junction. We report a case of black esophagus in a patient who presented with diabetic ketoacidosis (DKA). Case Description/Methods: A 62 year old male with poorly controlled diabetes mellitus presented with altered mental status after being found down with a reported episode of coffee-ground emesis. He was hypotensive on admission and was oriented only to self. Labs were significant for leukocytosis and multiple metabolic derangements including hyponatremia, hyperkalemia, acidosis, acute kidney injury, and hyperglycemia with a blood glucose of 1,878 mg/dL. He was admitted for hypovolemic shock secondary to DKA and was treated with vasopressors briefly, fluid resuscitation, and insulin. After resolution of DKA, he reported persistent dysphagia, epigastric pain, and nausea. Upper endoscopy was performed which showed friable circumferential black mucosal discoloration throughout the entire esophagus that spared the gastroesophageal junction. He was diagnosed with AEN and continued on a proton-pump inhibitor and sucralfate with improvement in symptoms. Repeat upper endoscopy was performed four weeks after discharge at which time the patient was endorsing recurrent dysphagia, epigastric pain and nausea. Upper endoscopy revealed a tight stricture in the mid esophagus requiring dilation.Discussion: AEN is a rare clinical entity, with an estimated incidence of 0.01%. Our patient developed AEN likely due to profound hemodynamic compromise in the setting of DKA. Due to its relatively limited blood supply, the distal esophagus is preferentially affected, while findings of pan-esophageal involvement is less common. AEN carries a mortality rate of 23-35% and can be complicated by superimposed infection, esophageal rupture, and stricture formation. While data is limited, the mainstay of therapy involves identifying and treating the underlying disease and supportive care to allow for mucosal healing. Given its high mortality rate, AEN must be considered and accurately diagnosed. Repeat endoscopy should be done to demonstrate healing due to the risk of complications. Figure 1. Endoscopic evidence of ‘black’ mucosa with associated esophagitis.Figure 2. Endoscopic image showing mucosal sparing of the GE junction.Figure 3. Repeat endoscopy 4 weeks later with tight stricture in mid-esophagus.Disclosures:Sunny Sandhu indicated no relevant financial relationships. Timothy Wang indicated no relevant financial relationships. Devang Prajapati indicated no relevant financial relationships.

P1160 (S2048). Awareness of Early Diagnosis and Surgical Management of Pediatric Intestinal Pseudo-Obstruction 1389632 Valerie Cabrera Leon University of Puerto Rico School of Medicine Awareness of Early Diagnosis and Surgical Management of Pediatric Intestinal Pseudo-Obstruction Functional Bowel Disease ePoster Session Valerie Cabrera Leon, MD, Victor Ortiz Justiniano, MD; University of Puerto Rico School of Medicine, San Juan, Puerto RicoIntroduction: Gastrointestinal motility is produced by two types of smooths of muscles in the gastrointestinal tract which are circular muscles and longitudinal muscles. These muscles are stimulated by a complex multifaceted connection between intrinsic enteric nervous system and central nervous system. The enteric nervous system is composed of Interstitial cells of Cajal, submucosal plexus, myenteric plexus, migratory motor complex and gut neuromodulators. Gut motility disorders are derived from numerous etiologies that arise from the muscular, nervous, cellular, molecular components. Pediatric intestinal pseudo obstruction is a disorder that needs early diagnosis and prompt treatment to avoid associated life-threatening complications.Case Description/Methods: A 27 weeks gestational age baby girl born to a 25 year G1P0 mother with history of abruptio placenta and chorioamnionitis was admitted to the neonatal intensive care unit due to extreme low birth weight and prematurity. Patients developed disseminated Herpes Simplex Virus infection complicated with left grade 2 intraventricular hemorrhage. Afterwards, patient developed persistent total parenteral nutrition dependence, enteral food intolerance, marked intestinal dilation and constipation for 4 months since birth. Rectal biopsies rule out Hirschsprung disease. Multiple abdominal x-rays showed marked diffuse intestinal dilation. Water soluble enema study revealed inflammatory changes suggestive necrotizing enterocolitis. Patient was taken to the operation room since no clinical improvement. Intraoperative findings included viable intestinal tissue without ischemic change and no mechanical obstruction. After negative exploratory laparotomy we decided to perform a rigorous review of literature regarding intestinal dysmotility disorders.Discussion: Our patient was diagnosed with pediatric intestinal pseudo obstruction based in our review of literature which is a intestinal motility disorder. Our plan was to perform multiple full thickness intestinal biopsies to confirmed diagnosis and surgical management with decompressive gastrostomy and ileostomy. Unfortunately, patient developed acute-clinical deterioration due to septic shock, catheter-related bacteremia and multiple organ failure. Functional motility disorders should be included as a differential diagnosis once mechanical obstruction rule out. Our aim is to provide awareness of early identification of PIPO and management since life-threatening complications may develop. Disclosures:Valerie Cabrera Leon indicated no relevant financial relationships. Victor Ortiz Justiniano indicated no relevant financial relationships.

P1240 (S2060). Gastrointestinal Tuberculosis: The Great Masquerader 1389302 Yufang Liu National University of Singapore Yong Loo Lin School of Medicine Gastrointestinal Tuberculosis: The Great Masquerader General Endoscopy ePoster Session Award: Presidential Poster AwardYufang Liu1, Gabriel Cher, MBBS, MRCP2, Gim Hin Ho, MD, MRCP2, Constantinos P. Anastassiades, MBBS2; 1National University of Singapore Yong Loo Lin School of Medicine, Singapore, Singapore; 2Khoo Teck Puat Hospital, Singapore, SingaporeIntroduction: Gastrointestinal tuberculosis (GI-TB) is the sixth most common presentation of extra-pulmonary TB. Diagnosis is challenging due to its mimicry of other conditions like neoplasia, inflammatory bowel disease, and other infections. Though rare in Singapore and other developed countries, this case report highlights GI-TB as an important differential diagnosis for gastrointestinal malignancy.Case Description/Methods: A 32-year-old female presented with right-sided abdominal pain and significant weight loss. Laboratory evaluation showed iron deficiency anemia. Computed Tomography (CT) revealed ileocolonic lymphadenopathy and a right iliac fossa mass with thickening of the terminal ileum (TI), cecum, and ascending colon (Figure A). Colonoscopy showed a circumferential and ulcerated ascending colon mass with severe stenosis precluding passage of a pediatric colonoscope across the stricture (Fig. B). Histology from endoscopic biopsy of the mass demonstrated ulceration, inflammatory granulation tissue and focal granulomatous histiocytic aggregates without caseous necrosis. There was no histopathologic evidence of malignancy. Acid-fast bacilli (AFB) smear and polymerase chain reaction (PCR) for TB and cytomegalovirus were negative. However, serum TB T-spot was positive. The patient's clinical course was soon complicated by symptomatic ascites. Ascitic fluid analysis for TB PCR, AFB smear and culture, and cytology was negative. Serum-ascites albumin gradient was 11g/L. As the diagnosis remained inconclusive, repeat colonoscopy with endoscopic biopsy of the mass lesion was performed. TB PCR and AFB smear were again negative but TB culture eventually grew Mycobacterium tuberculosis. The patient was treated for GI-TB for six months with symptom resolution. Follow-up colonoscopy was successfully completed to TI and showed resolution of the previous mass and associated stricture (Fig. C).Discussion: This case illustrates how GI-TB may present with non-specific clinical symptoms similar to other conditions including GI malignancies, inflammatory bowel disease and other gut infections. Its varied clinical manifestations may make diagnosis difficult and elusive. A high index of clinical suspicion for GI-TB should therefore be maintained when evaluating atypical cases. The approach to such cases requires a combined clinical, radiologic, endoscopic and histopathologic assessment for prompt diagnosis and management of these patients.Figure A: Initial Computed Tomography (CT) depicting mesenteric lymphadenopathy and marked thickening of the cecum, proximal ascending colon and terminal ileum associated with extensive fat stranding.Figure B: Initial colonoscopy showing a circumferential and ulcerated ascending colon mass with significant stenosis (tattooed area), preventing passage of a paediatric colonoscope.Figure C: Follow-up complete colonoscopy to cecum and terminal ileum showing resolution of ascending colon mass and associated stricture at previously tattooed site.Disclosures:Yufang Liu indicated no relevant financial relationships. Gabriel Cher indicated no relevant financial relationships. Gim Hin Ho indicated no relevant financial relationships. Constantinos Anastassiades indicated no relevant financial relationships.

P1250 (S2070). The First Reported Case of Diffuse Colonic Lipomatosis in a Patient With Lynch Syndrome 1389473 Rahul Chaudhari Pennsyl