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Gastric electrical stimulation (GES) is an accepted form of therapy for gastroparesis and is considered for compassionate therapy in patients with refractory nausea and vomiting. The U. S. Food and Drug Administration has approved GES for treatment of drug-refractory idiopathic gastroparesis and diabetic gastroparesis, but it has also been used off label for related conditions. Although GES has been shown to improve the frequency of nausea and vomiting in patients with idiopathic and diabetic gastroparesis, it has also shown benefit in patients affected by the symptoms of gastroparesis, ie, nausea, vomiting, and abdominal pain, but with nondelayed gastric emptying, referred to as gastroparesis-like syndrome or unexplained nausea and vomiting. Because not all patients with gastroparesis and gastroparesis-like syndrome benefit from GES, a trial of temporary gastric stimulation (Fig. 1) can help determine those who would benefit from placement of a permanent gastric stimulator, which requires surgery. The techniques for endoscopic and surgical placement of gastric electrical stimulators are not widely known or performed. The purpose of this video (Video 1, available online at www.VideoGIE.org). is to highlight the important aspects of temporary gastric electrical stimulator lead placement with advanced endoscopic techniques, which may then lead to the surgical placement of a permanent gastric stimulator.

Key Clinical MessageCalcium channel blocker toxicity can be devastating. Initial therapy with fluid, calcium, and adrenoreceptor agonists should be prompt and novel therapies can be added if no response. Determining cardiogenic shock versus vasoplegia with echocardiogram or other hemodynamic monitoring may guide treatment options.

Abstracts S92documented via medical record or telephone communication. Exclusion criteria included: no follow-up, chronic pancreatitis, pancreatic pseudocyst, mass rather than cyst on EUS, and normal EUS exam. Th e remaining 767 patients were categorized by cyst type based upon clinical diagnosis. If pancreatic duct was ≥ 5 mm, cysts were categorized as either main-duct-IPMN (no associated cyst) or mixed-type IPMN (one or more pancreatic cysts present). Otherwise, cysts were categorized as mucinous cystic neoplasm (3-cm or larger unilocular or septated cyst in the pancreatic body/tail in females ≥ 40 years in age), serous cystadenoma (unilocular cyst with honeycomb appearance) or branched duct-IPMN (unilocular or mutlicystic). Pancreatic cancer diagnosis was made by FNA cytology, surgical specimen or imaging showing pancreatic mass with metastases. Death was determined by review of the medical record, contacting family members or by online resources. Results: Fift y-eight percent were female with average age of 67 years. 69% were asymptomatic. Average follow-up was 4 years. BD-IPMN was the most common cyst type comprising 78% of all EUS examinations, followed by mixed type-IPMN (9%) and SCN (7%). MD-IPMN and MCN were the least common accounting for 2% and 4% of all cysts, respectively. Seventy-four patients were diagnosed with pancreatic cancer. Th ough nearly one half of cancers were diagnosed in patients with BD-IPMN this corresponded to an overall low risk (6%). Mixed type-IPMN had the highest risk of cancer development at 38% with a 62% survival-free-of-cancer at 5 years. Conclusion: Th is large, multicenter study of patients referred for EUS of pancreas cysts shows that BD-IPMN is the most common type of pancreatic cyst, however those with Mixed type IPMN suff er the highest risk of cancer development. Purpose:To determine the prevalence of various disease processes accounting for the common complaint of gas and bloating in the outpatient setting. Methods: Electronic billing and medical records in an outpatient gastroenterology clinic from 2010-2012 were utilized. Patient visits with a presenting complaint coded as 787.3, "fl atulence, eructation and gas pain, " were reviewed by three independent physicians. Patients under the age of 18 were excluded, as were patients with an existing diagnosis other than IBS. Only patients who underwent some form of evaluation (i.e., laboratory, biopsy, motility study, or breath testing) were included. Final diagnoses were divided into eight categories: Fructose Intolerance (FI), Lactose Intolerance (LI), Small Intestinal Bacterial Overgrowth (SIBO), Celiac Disease (CD), functional disorders, motility disorders, other and unknown. Diagnoses were not considered mutually exclusive, and presumptive diagnoses (i.e., improved with lifestyle changes alone) were counted as unknown in the absence of objective data. Summary statistics were applied using SPSS soft ware. Results: Two hundred thirty-seven patients were included in the study population. 23.6% were male and 76.4% female....