7022ONE UNIFORM ENDOSONOGRAPHIC LAYER REFLECTS A THINSUBSEROSAL ADIPOSE TISSUE OF THE NORMAL GALL-BLADDER WALL.Takafumi Yamamoto, Jun Matsumoto, Yasunobu Akasaki, MasaakiYamazato, Kazuaki Nakashio, Terukatsu Arima, Kagoshima Univ,Kagoshima, Japan.Introduction and aim: Endoscopic ultrasonography (EUS) plays a majorrole in diagnosis of the gallbladder lesions. The normal gallbladder wallhas been demonstrated to consist of 3 layers on EUS images. It is general-ly accepted that the 2nd and the 3rd layers include the muscularis propriaand subserosal fibrous tissue, and the subserosal adipose tissue, respec-tively. However these 3 layers cannot be seen in some normal gallbladderby EUS images. Therefore this study was aimed to clarify the cause ofthese 2 different EUS images seen normal gallbladder by histologicalstudy of the gallbladder wall performed simultaneously. Materials andmethods: Gallbladder specimens from 12 autopsy cases without biliarytract disorders, 6 with the three EUS layers (goup A) and 6 with one uni-form layer (group B), were enrolled in this study. Two needles were stabbedinto the gallbladder wall from the mucosa to perform EUS and histologicalstudy for the same area of the specimen. For this study an Olympus GF-UMQ 240 with a frequency of 7.5MHz was used. Results: Histology of thespecimens were summarized in the table. The thickness of the muscularispropria and fibrous layer showed no significant differences between groupA and B. While the thickness of the adipose layer of group B was deter-mined to be one half of group A. Conclusions: This study indicates that theone uniform layer seen in normal gallbladder on EUS images reflects athin subserosal adipose layer.

Table 1.

muscularis total mucosal propria and adiposewall layer fibrous layer layer

group A 2.18 0.13 0.85 1.37group B 1.88 0.16 0.80 0.68 (mm)

End Matter

7023ENTEROCLYSIS IN THE EVALUATION OF UNEXPLAINEDCHRONIC ABDOMINAL PAIN.Khalid Bazir, Korta Yuasa, Larry S. Miller, Temple Univ Hosp,Philadelphia, PA.Purpose: The purpose of this study was to evaluate the utility of entero-clysis (dedicated small bowel radiography) in the evaluation of chronicabdominal pain. Methods:A retrospective review of 34 consecutive patientswas done at Temple University Hospital (mean age of 42 years, 17 malesand 17 females) who had undergone enteroclysis for evaluation of chronicabdominal pain. All patients were initially worked up with EGD and colo-noscopy, and when these tests did not reveal a source for the chronicabdominal pain an enteroclysis was performed. Results:4/34(12%) of thepatients had an abnormal enteroclysis study. These patients included 2with small bowel patterns consistant with adhesions, 1 with dilitation ofthe proximal duodenum consistant with superior mesenteric artery syn-drome and 1 with ulceration in the ileum consistant with Crohns ileitis.Conclusions: In patients completely worked up with endoscopic procedures(i.e. colonoscopy and upper endoscopy) in which an explanation for chron-ic abdominal pain is not apparent, 12% of patients had an abnormal ente-roclysis finding which could have explained the chronic abdominal pain.Whether or not these findings actually contributed to the abdominal painremains unclear.Enteroclysis is an relatively insensitive test for the eval-uation of chronic abdominal pain but may be useful in a small percentageof patients after endoscopic evaluation if the source of chronic pain is notclear. In this study enteroclysis was most useful for defining adhesions2/4(50%) which were not picked up by endoscopic diagnostic tests. 1/4(25%)of the positive enteroclysis findings in this study was due to Crohn’s ileitis,and 1/4(25%) was due to a possible superior mesenteric artery syndrome.

7024RACIAL DIFFERENCES IN ACUTE UPPER GASTROINTESTINALBLEEDING (AUGB) IN EAST MALAYSIA.John L. Cheng, Jayaram Menon, Peter Ong, John T. Arokiasamy, QueenElizabeth Hosp, Kota Kinabalu, Malaysia; Univ Hosp, Kuala Lumpur,Malaysia.

Objective To see whether there is a racial difference in AUGB patients inSabah, East Malaysia. Methodology This prospective unselected popula-tion-based study is a part of an on-going multi-center study. All adultpatients presenting with AUGB between 1st July 1998 and Oct 31st 1999to the Queen Elizabeth Hospital, a tertiary referral center with a catch-ment population of about 650000, were recruited.AUGB was defined ashemetemesis, melena or coffee-ground vomits or nasogastric aspiratesneeding transfusion. Existing non-AUGB patients who bled were alsoincluded. Data were recorded on questionnaires based on an earlier vali-dated study.Results 674 patients presented with AUGB during the 15-month period, an incidence rate of 105.4 cases per 100,000 population.TheKadazandusuns (KDs), one of the major ethnic groups, have a significant-ly higher AUGB rate than expected. However, the other groups have lowerthan expected rates. (Table 1) Discussion This is the first large-scaleprospective study providing hitherto undefined AUGB racial compositiondata in multi-racial East Malaysia. The higher rate in KDs is interesting,as an earlier local blood bank-based study showed them to have a higherH.Pylori infection rate. This may be important, as analysis showed a largeproportion of KDs bled from peptic ulcer disease (PUD). The lower inci-dence in Chinese is at variance with other reported series. The lower ratein Malay patients is in keeping with a lower predisposition to PUD, as hasbeen shown earlier. Conclusion The KDs have a significantly higher thanexpected AUGB rate compared to the other races in East Malaysia.

Table 1

% Rate perRace No % Population‡ 100000

Chinese 158 23.44 29.9 82.7Malay 131 19.44 41.3 49.6Kadazandusun* 350 51.93 21.8 194.9Indians 7 1.04Others† 28 4.15

*(p<0.001) (Chi-Squared Test used); †Smaller indigenous groups; ‡StateStatistics Department, Sabah

7025IMPROVEMENT OF QOL BY STENT TREATMENT FORMALIGNANT GASTROINTESTINAL TRACT STENOSIS.Yoshinori Mizumoto, Kagami Matsuda, Masato Mizumoto, Nobuko Shima,Masao Naoki, Hiroshi Satake, Takama Maekawa, Yukio Kajitani, KochuKogawa, Kyoto National Hosp, Kyoto, Japan.Introduction The stent treatment for patients with malignant gastroin-testinal tract stenosis has become one of the popular endoscopic treat-ments and has become widespread at many hospitals. Many reports onstent treatments are about the experiences of using stents whereas fewstudies evaluated and discussed the improvements of QOL. This reportaims to evaluate the differences in the improvement of QOL by stent treat-ments according to the site of stenosis. Subjects Of these patients, the sub-jects were 93 cases in whom stent placement was successful. The lesionswere esophagostenosis in 39, gastric outlet obstruction (GOO) in 39, andlarge intestinal stenosis in 15 cases. The length of stenosis before operationwas 4.56, 5.54 and 5.67 cm, respectively, and the performance status (PS)before operation was 3.15, 3.18 and 3.13, respectively. With the dysphagiascore (DS) as 0 point- no dysphagia, 1 point- dysphgia for solid food, 2points- dysphagia for semi-solid food, and 3 points- dysphagia for liquids,DS before operation was 2.51, 2.69 and 2.40, respectively. Method Theimprovement in QOL according to the site of stenosis was evaluated, byclarifying the eating conditions before and after the operation, theimprovement in the constitutional symptoms, the ratio of returning home,survival time, and home staying time. Results PS after operation wasimproved to 2.28, 2.39 and 2.73, respectively. DS after operation was alsoimproved to 1.33, 1.56, and 1.53, respectively. The ratio of returning homewas 53.8, 46.2 and 50.0%, respectively, and the ratio was high inesophagostenosis patients. Also the mean survival time was 199.8, 160.2and 229.8 days, respectively. The meal home staying period was 102.9, 69.1and 157.2 days, respectively. Discussion (1) PS and DS were improved bystenting at all sites of stenosis. (2) The ratio of returning home was not dif-ferent at all sites of stenosis. (3)Although the survival time was not differ-ent, there was a tendency that home staying time was prolonged inpatients with esophgostenosis and large intestinal stenosis. ConclusionStenting is effective not only in esophagostenosis but also in GOO andlarge intestinal stenosis, and contributes in the improvement of the QOL.

VOLUME 51, NO. 4, PART 2, 2000 GASTROINTESTINAL ENDOSCOPY AB247