Sa1501 The Efficacy of Tacrolimus and the Usefulness of Endoscopy in Predicting Its Efficacy in Patients With Refractory Ulcerative Colitis

screening method. We designed an open-label controlled trial to compare CTC, CS, and BE for diagnosing colorectal cancer or polyps in FOBT-positive patients. Methods: We enrolled 1,500 consecutive patients who had undergone CTC, CS, or BE screening at the 114 hospitals that comprise the Okazaki city medical association. Each institution selected a screening program based on a discussion with the doctor in charge, and diagnoses of colorectal cancer, large (R10 mm) polyps, or smaller polyps were evaluated. CTC was performed using barium-based fecal tagging. Results: The subjects were divided equally into CTC, CS, and BE groups (n Z 500 each, age SD: 68.4 12.8 years, 66.2 12.7 years, and 67.3 13.4 years, respectively; proportion of women: 51%, 42%, and 49%, respectively). The CS group was significantly younger and had more men than the CTC and BE groups. Colorectal invasive cancer was diagnosed in 28 (5.6%) patients for each of the three groups. The detection rate for large polyps was significantly lower in the CTC group than in the CS group (11.0% vs. 21.2%; P! 0.05), and was almost equal to the rate in the BE group (11.0% vs. 16.8%). The detection rate for smaller polyps (5-9 mm) was significantly lower in the CTC group than in the CS group (17.0% vs. 25.0%; P! 0.05), and was almost equal to the rate in the BE group (17.0% vs. 15.6%). The frequency of no polyps was 332 (66.4%), 241 (48.2%), and 305 (61.0%) in the CTC, CS, and BE groups, respectively. The frequency of a diagnosis throughout the colon was significantly lower in the CTC group (382, 76.4%) than the CS group (438, 87.6%) and BE (438, 87.6%) (P! 0.05) groups. Additional examinations were required for the CTC (34, 6.8%), CS (61, 12.2%), and BE (24, 4.8%) groups. The cause of inadequate examination included excessive fluid or stool (33, 97.1%), spasms (8, 23.5%), or both (7, 20.6%) in the CTC group; not acceptable (56, 91.8%) or stenosis due to an advanced tumor (5, 8.2%) in the CS group; and excessive fluid or stool (17, 70.8%), spasms (3, 12.5%), or both (2, 8.3%) in the BE group. Conclusion: CTC provides the same diagnostic sensitivity for colorectal cancer (vs. CS and BE) and for polyps (vs. BE). Therefore, CTC should be used to examine FOBT-positive patients for colorectal cancer and polyps. Sa1501 The Efficacy of Tacrolimus and the Usefulness of Endoscopy in Predicting Its Efficacy in Patients With Refractory Ulcerative Colitis Osamu Watanabe*, Masanao Nakamura, Takeshi Yamamura, Kazuhiro Morise, Masanobu Matsushita, Asuka Nagura, Keiko Maeda, Toru Yoshimura, Arihiro Nakano, Hiroshi Oshima, Junichi Sato, Yasuaki Ueno, Masashi Saito, Rinzaburo Matsuura, Yasuyuki Mizutani, Kazuhiro Furukawa, Kohei Funasaka, Eizaburo Ohno, Ryoji Miyahara, Hiroki Kawashima, Kazuhiro Ishiguro, Yoshiki Hirooka, Takafumi Ando, Hidemi Goto Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan Background and Aim: Many patients with refractory ulcerative colitis (UC) are likely to require surgery in spite of pharmacological treatment. Tacrolimus, a calcineurin inhibitor, is expected to be an effective alternative drug which allows colectomy to be avoided. We retrospectively investigated patients with refractory UC treated with tacrolimus. Patients and Methods: Forty-seven patients with moderate or severe UC were treated with oral tacrolimus between July 2009 and June 2013 at our hospital. Dosage was adapted to achieve trough levels between 10 and 15 ng/mL for the first two weeks and between 5 and 10 ng/mL after the 3rd week. Clinical disease activity was calculated at baseline and weeks 2, 4 and 12 using the Lichtiger’s clinical activity index (CAI). A CAI score of 4 and below was defined as clinical remission. Sigmoid colonoscopy was performed at baseline and week 2 in 15 patients. Endoscopic activity was assessed by the presence or absence of endoscopic findings (ulcer, bleeding, edema, mucopurulent discharge, vascular pattern) and was also calculated using Rachmilewitz’s endoscopic index (EI) at baseline and week 2. Results: After four weeks of tacrolimus therapy, 28 patients (60%) showed a complete response to this therapy, 6 (13%) had mild to moderate disease activity, and 12 (27%) showed no response. One patient discontinued treatment due to light-headedness. Of the 20 of 47 patients with severe disease, 13 (65%) obtained complete remission. Fifteen of the 20 patients with severe disease were fasted for the first two weeks, of whom 12 (80%) entered complete remission, whereas 5 severe patients with oral intake were unresponsive to therapy without one patient. After 12 weeks of tacrolimus therapy, 25 of 28 patients who responded at the fourth week remained in remission. Corticosteroids (CS) were then tapered and discontinued. The mean dosage of CS was 18.5 mg/day before tacrolimus therapy and 2.1 mg/day after 12 weeks (p! 0.001). Sigmoid colonoscopy was performed in 15 patients at baseline and week 2. Eleven of ...