Tu1079 UN-TUTORED TRAINING PATHWAY TO ACHIEVE COMPETENCE IN ESOPHAGO-GASTRIC ENDOSCOPIC SUBMUCOSAL DISSECTION IN A WESTERN CENTRE

Abstract

96 (28-327) days since HCST. The most common diagnoses were AML 55/159 (34.6%), B-ALL 30/159 (18.9%), and CML 14/159 (8.8%). Diarrhea 105/159 (66.0%), nausea/vomiting 63/159 (39.6%), and abdominal pain 31/159 (19.5%) were the most common indications for evaluation of GVHD. Abnormal pathology was most frequently found in the stomach 74/159 (46.5%), duodenum 66/159 (41.5%), and sigmoid colon 54/159 (34.0%). The majority of patients were on tacrolimus 101/159 (63.5%), sirolimus 70/159 (44.0%), and hydrocortisone 59/159 (37.1%) immunosuppression. Bleeding occurred following 5/159 (3.1%) endoscopies, with successful hemostasis in all cases. Death within 1 month of endoscopy occurred in 7/159 (4.4%). A pre-procedure platelet count above 50x10 3 /mL (OR, 0.24; 95% CI, 0.06-0.94; PZ0.04) and increased pre-procedure hemoglobin (OR, 0.54; 95% CI, 0.33-0.88; PZ0.01) were associated with decreased odds of adverse outcome following endoscopy. Discussion: Although a platelet cutoff above 50x10 3 /mL was associated with lower odds of adverse events post-endoscopy, the overall risk of endoscopic procedures was low. In our series, under 4% of endoscopic interventions resulted in bleeding, infection, or fever. As expected, patients with higher pre-procedure hemoglobin conferred a decreased risk of adverse events. Pre-procedure ANC was not significantly associated with adverse outcome. Further characterization of safety at different platelet thresholds is necessary to inform the decision to proceed with endoscopy in this at-risk population.