THE SOCIETY FOR SURGERY OF THE ALIMENTARY TRACT 53rd Annual Meeting May 18-22, 2012 San Diego Convention Center San Diego, California Program Book ABStrACt SuPPleMent Table of Contents Schedule-at-a-Glance .............................................................................................................2 Sunday Plenary and Video Session Abstracts ........................................................................4 Monday Plenary and Video Session Abstracts .....................................................................17 Tuesday Plenary, Video, and Quick Shot Session Abstracts .................................................51 Sunday Poster Session Abstracts ..........................................................................................61 Monday Poster Session Abstracts .......................................................................................110 Tuesday Poster Session Abstracts .......................................................................................158 THE SOCIETY FOR SURGERY OF THE ALIMENTARY TRACT PROGRAM BOOK ABSTRACT SUPPLEMENT FIFTY-THIRD ANNUAL MEETING San Diego Convention Center San Diego, California May 18–22, 2012 THE SOCIETY FOR SURGERY OF THE ALIMENTARY TRACT Schedule-at-a-Glance FRI, MAY 18, 2012 SATURDAY, MAY 19, 2012 SUNDAY, MAY 20, 2012 Exhibit 28ab 28abcdOther 26ab 27b 28ab 28cd Other Hall 7:00 AM 7:15 AM 7:30 AM 7:45 AM OPENING SESSION 8:00 AM 8:15 AM PRESIDENTIAL 8:30 AM PLENARY A 8:45 AM (PLENARY SESSION I) 9:00 AM 9:15 AM PRESIDENTIAL 9:30 AM DDW CCS: ADDRESS Mgt of Pt @ High @ of Pt Mgt 9:45 AM Colon CA Risk for 10:00 AM 10:15 AM 10:30 AM PRESIDENTIAL 10:45 AM PLENARY B 11:00 AM (PLENARY SESSION II) 11:15 AM CA (by invitation only) STATE-OF-THE-ART w/Obesity DDW CTS: DDW CTS: DDW CCS: DDW CCS: DDW CCS: DDW CCS: GI Mgt of Pt 11:30 AM in Probiotics Tx of Early GI LECTURE 11:45 AM Disease & Health 12:00 PM 12:15 PM 12:30 PM 12:45 PM 1:00 PM RESIDENTS & FELLOWS RESEARCH CONFERENCE 1:15 PM MEET-THE- PROFESSOR 1:30 PM LUNCHEONS 1:45 PM 2:00 PM 2:15 PM MAINTENANCE OF CERTIFICATION COURSE: 2:30 PM 2:45 PM 3:00 PM Evidence Based Treatment of Hepatopancreatobiliary Diseases GI SURGERY 3:15 PM DDW CCS: Mgt of Fecal Incontinence Colitis; Pancreatic Cystic Neoplasms DEBATES A: C Diff POSTER SESSION I (authors available @ posters 12:00 PM - 2:00 PM) 3:30 PM CONTROVERSIES IN 3:45 PM CONFERENCE: 4:00 PM VIDEO SESSION I: Robotic, Endoscopic, & & Endoscopic, Robotic, Adv. Laparoscopic GI Sx Laparoscopic GI Adv. 4:15 PM STATE-OF-THE-ART Colon and Rectal Cancer the Surgical Treatment of PLENARY SESSION III 4:30 PM Technological Advances in WARD WARD Duct Stone CLINICAL Difficult Bile Bile Difficult 4:45 PM I: ROUNDS 5:00 PM 5:15 PM 5:30 PM 5:45 PM 2 12:45 PM 12:30 PM 12:15 PM 12:00 PM 11:45 AM 11:30 AM 11:15 AM 11:00 AM 10:45 AM 10:30 AM 10:15 AM 10:00 AM 9:45 AM 9:30 AM 9:15 AM 9:00 AM 8:45 AM 8:30 AM 8:15 AM 8:00 AM 7:45 AM 7:30 AM 7:15 AM 7:00 AM 5:45 PM 5:30 PM 5:15 PM 5:00 PM 4:45 PM 4:30 PM 4:15 PM 4:00 PM 3:45 PM 3:30 PM 3:15 PM 3:00 PM 2:45 PM 2:30 PM 2:15 PM 2:00 PM 1:45 PM 1:30 PM 1:15 PM 1:00 PM QUICK 26ab 27b 28ab 28cd SHOTS SESSION I QUICK 18–22,2012•SANDIEGO,CA 53RD ANNUALMEETING•MAY PUBLIC POLICY SHOTS PLENARY PLENARY & ADVOCACY SESSION SESSION V SESSION IV PANEL III MONDAY, MAY21,2012 Schedule-at-a-Glance ORATION SSAT/ASCRS QUICK GUEST SSAT/AHPBA ANNUAL VIDEO SESSION II: JOINT SHOTS JOINT BUSINESS SYMPOSIUM: BREAKFAST AT SYMPOSIUM: SESSION MEETING Benign Liver THE MOVIES Ulcerative Colitis II Neoplasms CLINICAL CONTROVERSIES IN GI SURGERY VIDEO CLINICAL WARD DEBATES B: Band / SESSION III: WARD ROUNDS III: Morbid Obesity; 360 v HPB & ROUNDS I: GI Sx & Partial Fundoplication / Foregut Diverticulitis Endoscopy GERD Exhibit Hall POSTER SESSION II (authors available @ posters 12:00 PM - 2:00 PM) 3 DDW CCS: DDW CCS: Mgt MEET-THE- DDW CCS: Other 27b 28ab 28cd Pancreatic Cystic of Complicated PROFESSOR Disorders of the Neoplasms & IPMN Crohn's LUNCHEONS Esophagus PLENARY PLENARY SESSION VII SESSION VI SSAT/ISDS JOINT SSAT/SAGES JOINT B'FAST LUNCHEON SYMPOSIUM: SYMPOSIUM: TUESDAY, MAY22,2012 Foregut Motility Optimizing Outcomes HEALTH CARE & QUALITY OUTCOMES PANEL: GI Sx Cost Curve Exhibit Hall POSTER SESSION III (authors available @ posters 12:00 PM - 2:00 PM) DDW CCS: DDW CCS: MEET-THE- Endoscopic Can You DDW CCS: Other PROFESSOR Biliary Eliminate Mgt of HCC LUNCHEONS Complications Barrett's? BEST OF DDW THE SOCIETY FOR SURGERY OF THE ALIMENTARY TRACT SSAT PLENARY, VIDEO, AND QUICK SHOT ABSTRACTS Printed as submitted by the authors. indicates a paper that is also being presented at the Residents & Fellows Research Conference. Participation in and attendance at this conference is by invitation only. indicates a video presentation scheduled during a Plenary Session. Sunday, May 20, 2012 8:15 AM – 9:15 AM 28ab PRESIDENTIAL PLENARY A (PLENARY SESSION I) 287 provided an additional six million patient visits. Texas hos- pitals have saved $100 million /year which has allowed Texas Tort Reform Increased Access to Health Care them to deliver more charity care ($500 million/year), Ronald M. Stewart1, Lisa Rocheleau2, Kenneth Sirinek1 expand patient safety programs (58%), subsidize short- 1. Surgery, UTHSCSA, San Antonio, TX; 2. Boone & Rocheleau, falls in government programs such as Medicaid (46%), San Antonio, TX raise salaries for nurses and increase nurse staffi ng (46%), Prior reports have confi rmed that comprehensive tort and maintain, improve or add new equipment (39%). In reform in Texas (2003) has resulted in fewer malpractice conclusion, medical liability reform enacted by the Texas claims and lawsuits against physicians and a reduction in Legislature in 2003, has afforded Texans an increased abil- the cost of both insurance premiums and the associated ity to access health care and would appear to be an ideal litigation fees. We hypothesize that Texas medical liability tort reform template for adoption by the other 49 states. reforms have achieved the Legislature’s intent of improving 288 statewide access to critical health care services. The posi- tive impact on physician manpower has been monumental Enhancement of the Small Bowel Obstruction Model with 21,000+ new medical licenses issued since tort reform with the Use of the Gastrografi n Challenge Test (62% for past 3 years compared to the 3 years pre-tort Naeem Goussous, Patrick W. Eiken, Micheal P.P.Bannon, reform). The number of new licenses issued by the Texas Martin D. Zielinski Medical Board in 2008 was 3,600 (a record high) compared Mayo Clinic, Rochester, MN to 2000 for the year 2001 (lowest for the preceding 10 BACKGROUND: years). Eight in ten Texas hospitals have reported that it Based on previous published data on is now easier to recruit medical specialists in the wake of small bowel obstruction (SBO) management, a three fea- tort reform. Since 2003, 218 new obstetricians have come ture model has been adopted in our institution predict- to Texas with 27% practicing in medically underserved ing the need for exploration. Obstipation combined with areas and all 254 counties now have at least one obste- mesenteric edema and lack of the small bowel feces sign trician. Similar increases have occurred in neurosurgery, on computed tomography (CT) were associated with the emergency medicine, cardiology, cardiovascular surgery, need for exploration. Patients with 2 or less features were orthopedic surgery, pediatrics, and geriatrics. Eleven coun- managed non-operatively and administered a Gastrografi n ties have their fi rst general surgeon and 24 counties have (GG) challenge. added at least one general surgeon. The Rio Grande Valley, HYPOTHESIS: We hypothesize that the (GG) challenge a former hotbed of medical malpractice claims, has seen an test, when used in combination with the predictive model, infl ux of 220 physicians. Although impossible to document will decrease the rate of explorations in patients not meet- except from medical society hearsay, there has been a posi- ing the criteria for immediate operation. tive manpower impact from the physicians who reversed METHODS: IRB approval was obtained to review patients their decision to retire as a result of tort reform implemen- admitted with SBO from November 2010 to September tation. The Texas Medical Association has estimated that 2011. Presenting with signs of strangulation or all three fea- this additional physician manpower since tort reform has 4 53RD ANNUAL MEETING • MAY 18–22, 2012 • SAN DIEGO, CA tures, and those who had an abdominal operation within 6 weeks of admission were excluded. All patients had an 290 abdominal/pelvic CT scan and GG challenge upon diagno- Abstracts Time-Trends and Disparities in Lymphadenectomy Sunday sis. GG patients were compared to historic controls man- for Gastrointestinal Cancer in the United States: A aged without the GG (July to December 2009). Successful GG challenge was considered as the presence of contrast in Population-Based Analysis of 342,792 Patients 1 1 1 the colon after an 8 hour plain abdominal fi lm or a bowel Attila Dubecz , Michael Schweigert , Rudolf J. Stadlhuber , motion. Data is presented as medians or percentages. Sig- Norbert Solymosi2, Jeffrey H. Peters3, Hubert J. Stein1 nifi cance was considered at p < 0.05. 1. Surgery, Klinikum Nurnberg, Nurnberg, Germany; RESULTS: One hundred and thirty three patients with a 2. Veterinary Medicine, Szent István University, Budapest, diagnosis of SBO were identifi ed (47% male) with 54 receiv- Hungary; 3. Division of Thoracic and Foregut Surgery, Department ing GG (study) and 79 historic control patients. There was of Surgery, University of Rochester School of Medicine and no difference in age (71 vs 65 years), prior SBO (52% vs Dentistry, Rochester, NY 47%), diabetes mellitus (20% vs 18%), history of malignancy BACKGROUND: The value of lymphadenectomy in most (35% vs 41%) or cardiac disease (29% vs 37%).