lesion, Forrest classification, endoscopic treatment, transfusion, urgent surgery, hospitaliza-tion or outpatient, hemorrhagic recidive and Rockall score). Our outcomes were mortalitydirectly related to the hemorrhage (in-hospital), mortality up 30 days and length of stay inhospitalized patients. For statistical analysis we used the Chi-square test and t Student test,with p<0.05 as significant differences. Results: 832 patients (532 male, 300 female), withmedian age 69 years; admission in weekdays 610 patients (73.1%) and weekend/holydays222 patients (26.6%). The groups A and B are similar (Table) Mortality in-hospital 24patients (2.88%)(6 patients admitted weekend/holidays vs 18 patients in weekdays, p=1),and total mortality 41 patients (4.92%) (9 patients admitted in weekend/holydays vs 32patients in weekdays, p=0.588); length stay of hospitalized patients 5.4 ± 4.7 days (5.4 ±4.4 in group A vs 5.5 ± 5.9 in group B, p=0.873). Conclusions: In our hospital does notexist weekend effect on patients with NVUGIH

S1098

Suboptimal Utilization of Antiplatelet Therapy in the Setting of Treated PepticUlcer Disease Bleeding Post Coronary Artery StentingFreddy Caldera, Debabrata Mukherjee, Tracy E. Macaulay, Maria S. Melguizo, Lisbeth A.Selby

According to the American Heart Association 16.8 million Americans carried the diagnosisof coronary artery disease (CAD) in 2006. Percutaneous coronary intervention and coronarystenting have changed the management of CAD. The use of coronary artery stents hasincreased the need for dual anti-platelet therapy, generally aspirin and clopidogrel. Protectivecardiovascular effects are balanced with increased bleeding including risk of overt gastrointes-tinal bleeding; within 30 days the risk is 1.3% with overall risk of 3%. Further complicatingdecision making is that early discontinuation of dual anti-platelet therapy in this settingmay lead to stent thrombosis in 29% of patients with an 80% mortality. The aim of thestudy was to characterize physician management of anti-platelet therapy post coronaryartery stent placement in patients who develop gastrointestinal bleeding. We developed ananonymous survey of internal medicine and family medicine residents and physicians. Thesurvey contained demographic items and 12 questions, about a variety of GI topics inaddition to the index study question. All US internal and family medicine program directorswere invited to encourage their residents and faculty to participate. A 55 year old with DM,HTN and coronary artery disease had a drug eluting stent placed 3 months ago. For stentpatency the patient is on ASA 81mg and clopidogrel 75mg daily. He presents to ER withan upper GI bleed; on endoscopy he is found to have a bleeding gastric ulcer that is treatedappropriately. Four days after admission he is ready for discharge. What would you do withhis anticoagulation? Acceptable answers were: 1) Consult cardiology, or 2) continue ASA& clopidogrel. Incorrect answers were stopping one or both agents. 581 surveys werecompleted by attending physicians (39%) and residents (61%). Forty-two percent werefamily practice physicians and 56% were internal medicine physicians responding. 75%responders practice in an academic setting. When presented with the case patient, only38.1% of the subjects chose to continue aspirin and clopidogrel therapy. Our survey suggeststhat primary care physicians do not appropriately manage dual anti-platelet therapy inpatients with peptic ulder bleeding after recent PCI. Once the source of bleeding has beendefinitively treated, early re-introduction of dual anti-platelet therapy is indicated to preventthe devastating complication of stent thrombosis. As gastroenterologists we should take astronger role in educating primary care providers about the relative safety of anti-plateletagents in the setting of treated peptic ulcer bleeding.

S1099

Risk Factors for Gastrointestinal Bleeding in Patients With Drug ElutingStents Placement: A Pilot Case Control Study in Japanese Multicenter.Kazuhide Higuchi, Eiji Umegaki, Akihito Nagahara, Mototsugu Kato, Keisuke Kimura,Tomoyuki Ota, Shin'ichi Takahashi, Shojiro Yamamoto, Akiko Shiotani, Toshio Watanabe,Tetsuo Arakawa, Hideyuki Hiraishi, Kazunari Kanke, Seiji Hokimoto, Kazuma Fujimoto,Hisao Ogawa

Widespread use of drug eluting stents (DES) has led to dramatic improvement in acutecoronary syndrome. After stenting, it is usually required to receive the dual anticoagulanttherapy as low-dose aspirin (L-ASP) and thienopyridine (ticlopidine: TIC, clopidogrel: CLO),leading to prevent gastrointestinal bleeding. This multicenter case control study in Japanwas to compare background factors for patients with gastrointestinal bleeding (cases) andnon-bleeding patients (controls) after DES. Methods; We enrolled 22 gastrointestinal bleed-ing cases with endoscopy, and no bleeding patients with DES as controls at the same time

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as the bleeding cases from 2006 to present. Results; As indicated in table, age (75.5±11.4vs 65.9±8.4, P<0.01) and ulcer history (27.3% vs 6.0%, P = 0.02) were significant riskfactors for bleeding of the patients with DES. The bleeding odds were 1.1 for age (1.0 -1.2, P = 0.001), and 5.9 (1.3 - 26.3, P = 0.02) for ulcer history. Ulcer characteristics of 22bleeding ulcers were as follow; bleeding sites: stomach 14, duodenum 7, small intestine 1;Forrest I/II/III: 7/10/4; single ulcer/multiple ulcer: 6/22; period from stent placement untilbleeding: 222.5 ± 263.1 days (1 - 903 days). Bleeding gastric ulcers were more commonin males than duodenal ulcers (92.9% vs 57.1%, P = 0.0309). BMI was higher (24.9±3.7vs 19.1±1.2, P = 0.0017), and the period until bleeding occurred was shorter (125.6±133.8vs 328.7±302.1 days, P = 0.0433) in gastric ulcers. Concomitant use of PPI and H2 receptorantagonists (H2RA) was limited in the patients with DES in Japan as indicated in table, andthe use was more common in acute myocardial infarction (72.75 vs 28.6%, P = 0.03). Theratio in the concomitant use of PPI and H2RA was the same in bleeding and control groups.Conclusion; Advanced age and past ulcer history were major risk factors for gastrointestinalbleeding following DES placement. PPI and H2RA were prescribed for high risk patients,but the prophylactic effect of these agents was not demonstrated in this study, whichwarrants a further prospective study to evaluate their effect on bleeding suppression afterDES placement.

S1100

The Utility of Transcatheter Angiography and Embolisation in theManagement of Refractory Peptic Ulcer HaemorrhageJavaid Iqbal, Usman Aujla, Alistair Craig, Yogananda Reddy, Alistair Makin, NicholasChalmers, Gerard Murphy, Finn Farquharson, Stephen Butterfield, Raymond Ashleigh,Jayapal Ramesh, Belkys B. Husein, Timothy Cooksley

INTRODUCTION: Themajority of patients with upper GI haemorrhage are managed success-fully by resuscitation, endoscopic therapy and intravenous proton pump inhibitors (IV PPI).Rebleeding can occur in up to 25% of patients; who are then retreated with endotherapyor referred for surgery. This group of patients has a high mortality and surgery is associatedwith high morbidity. The role of minimally invasive angiography in this cohort of refractorybleeding ulcers has not been studied in the post IV PPI therapy era AIMS & METHODS:We evaluated the use of embolisation in the management of uncontrolled peptic ulcer relatedGI bleeding. Data from patients who underwent angiography at two teaching hospitalsbetween March 02-March 08 for ongoing peptic ulcer haemorrhage was retrospectivelyreviewed. 24 patients were on IV omeprazole (40mg) prior to endoscopy, except 1 patientwho received oral lansoprazole (30mg) and all were treated with continuous infusion of IVomeprazole following index endoscopy RESULTS: 42 patients underwent angiography forupper GI bleeding of which 25 had peptic ulcer bleeding with a mean age of 70 (34-92)years; 18 (72%) patients being male. Median pre and post endoscopy Rockall scores were5 (range 3-7) and 7 (range 4-9) respectively. Diagnosis was duodenal ulcer 19 (76%), gastriculcer 4 (16%) and gastroduodenal ulcer in 2 (8%) cases. Endoscopic therapy was given in16 (64%) cases. This was dual or triple therapy in 11 (69%) and single modality therapy(adrenaline injection) in 5 (31%). Second look endoscopy was performed in 16 (72%)patients of whom 4 (25%) had further endoscopic therapy. Angiography was attempted inall and coil embolisation was performed in 23 (92%) patients where a bleeding point wasidentified. In the remaining 2 (8%) there was no identifiable source of bleeding, andembolisation was not performed. 6 patients had a 2nd angiogram; 1 resulted in therapy ina previously untreated patient. 1 patient had surgery for ongoing bleeding. There were 6(24%) deaths at a mean time of 21 days (range 4-36) from admission. This was due touncontrolled bleeding in 3 cases (12%) and pneumonia in the remainder. This gives atechnical success of 100% with an initial clinical success of 72%, and eventual success rateafter repeat angiogramwas 84%CONCLUSION: Transcatheter angiography and embolisationplays a significant role in the management of peptic ulcer bleeding when endoscopic therapyand IV PPI fail. This maybe considered as an alternative to surgery, however further studiesare needed to substantiate this claim

S1101

Non Variceal Upper Gastrointestinal Hemorrhage (NVUGIH): EpidemiologicalChanges in Two Periods of Time (1994-1997 and 2005-2008)Pedro Almela, Marta Bañuls, Rosario Anton, Pilar Mas, Vicente Sanchiz, Isabel Pascual,Miguel Minguez, Adolfo Benages

Objective: The aim of this study was to investigate the clinical, therapeutic, and outcomechanges in NVUGIH patients in two periods of time. Patients and Methods: Prospectivestudy on patients with NVUGIH covering two time periods (cohort A: 1.1.1994 to 30.9.1997and cohort B: 1.1.2005 to 31.12.2008). All the patients were attended in the emergencydepartment of a university hospital in Valencia (Spain). The cohort A includes 968 patientsand the cohort B 832 patients. We have analyzed the differences between both cohortsrespect to demographic data, clinical and endoscopic characteristics, and outcome. Forqualitative parameters we used the chi-square and the t Student for quantitative parameters,

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