and hospital charges using STATA 17. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results: We identified 1,198,839 patients with IBD of which 235,880 patients were matched to those with anxiety. Average age was 52.04 years. There was a significant decrease in inpatient mortality (OR 0.56, CI 0.51-0.62, P , 0.0001) and total cost of hospitalization (-$3,242.13, CI -4,259.55 --2224.70, P , 0.0001), but hospital length of stay increased (0.27 days, CI 0.20-0.34, P , 0.0001) between patients with IBD with cannabis use when compared to IBD patients without cannabis use. Conclusion(s):The different clinical manifestations and symptoms of IBD may cause several psychological changes in patients. Past studies demonstrated that psychological stress and disorders can trigger flares and relapses in patients with IBD. Our study showed that there was a statistically significant decrease in inpatient mortality and hospital LOS for patients with both IBD and anxiety compared to those with only IBD. Anxiety is known to be 2 to 3 times higher in patients with IBD, but it reduces morbidity and mortality. This may be due to the increased surveillance and treatment to this subgroup of patients. Given the known association between IBD and anxiety, clinicians be vigilant in detecting and treating concomitant anxiety as this could lead to better outcomes in this patient population, as our study revealed. Future randomized control trials are needed to further study the impact of anxiety on IBD.

Whereas typical Crohn’s disease is confined to the terminal ileum and presents with abdominal pain and diarrhea, gastroduodenal manifestations of Crohn’s disease are rare, with often asymptomatic patient presentations and inconclusive diagnostic testing. It is, however, a more severe form of Crohn’s disease and thus warrants treatment with steroids and biologics much earlier than its ileocolonic counterpart. We present the case of a young, otherwise healthy, male with newly diagnosed ileocolonic Crohn’s disease with concurrent gastroduodenal involvement that initially failed management with biologic agents. We discuss the clinical manifestations and often obscure pathology of gastroduodenal Crohn’s disease and highlight the necessity of performing a concurrent esophagogastroduodenoscopic evaluation on newly diagnosed ileocolonic Crohn’s disease to assess the presence of upper gastrointestinal involvement.

Introduction: Gastrointestinal (GI) sites of metastatic breast cancer (BC) are rare, compared to more frequent sites of bone, lung and brain. Incidence of stomach metastasis from primary tumors is , 1-2%, and according to literature as low as 0.3% from primary BC. The hormone receptor profile of metastatic sites is discordant in up to 15% of cases with triple negative metastatic sites from primary hormone receptor positive tumors. We present a case of metastatic BC to the stomach with tumor discordance. Case Description/Methods: A 49-year-old African American female was admitted after undergoing an esophagogastroduodenoscopy (EGD) for complaints of progressive dysphagia, 50 lb. weight loss, and reflux for 6-months. 10-years ago, patient was diagnosed with Stage II estrogen receptor (ER) and progesterone receptor (PR) positive, human epidermal growth factor receptor 2 (Her-2/neu) negative, invasive ductal carcinoma with lobular features. She underwent right breast lumpectomy and was treated with tamoxifen successfully. 4-years ago, inflammatory breast changes and flank pain revealed cancer recurrence with osseous metastasis. She was treated with several hormonal chemotherapies and radiation, and her disease was stable on a positron emission tomography scan 6-months ago. Bone marrow biopsy 1-month ago revealed ER/PR1 disease with PIK3CA gene mutation, with a treatment regimen of alpelisib and fulvestrant. EGD revealed nodular, erythematous, friable mucosa at the distal esophagus, causing inability to transverse EGD scope further (A). EGD scope was changed to ultraslim endoscope and advanced to show gastric mucosa that was nodular, friable, with ulcerations that bled upon contact with endoscope (B). Immunohistochemistry stain (IHC) of gastric biopsies revealed ER/PR/Her-2/neu negative (triple negative), cytokeratin 7 (CK7) and GATA binding protein 3 (GATA3) positive, metastatic breast carcinoma (C,D). Surgery was consulted for jejunostomy tube placement to provide nutrition and confirmed severe malignancy encasing the entire stomach. Discussion: Triple negative BC can rarely metastasize to the stomach, often mimicking primary gastric malignancy on initial presentation. Clinicians should have a higher index of suspicion for metastases in the setting of previous diagnosis of BC, to not delay potential therapies. Timely EGD biopsies, with useful BC specific markers on IHC staining (CK7 and GATA3), assisted in a rare diagnosis of a metastatic discordant triple negative BC in the stomach. [3565] Figure 1. (A) EGD view of distal esophagus. (B) Ultrathin endoscope view of abnormal stomach mucosa. (C) Ultrathin endoscope view of abnormal stomach mucosa. (D) Rare, poorly differentiated malignant cells -consistent with breast primary -that on IHC stain are positive for CK7 and GATA3. Tumor cells are negative for ER, PR, CDX2, CK20.

Introduction: Gastric laparoscopic adjustable banding (LAGB) is a weight loss procedure in which a band is inflated around the proximal stomach to effectively create a pouch, satiety and resultant weight loss. A known complication of LAGB is band erosion into the lumen of the stomach, typically requiring surgical excision. We present a case report of an endoscopic removal of the eroded gastric lap band with upper endoscopy (EGD) utilizing readily available tools from the endoscopy unit. Case Description/Methods: A 45-year-old female with a history of obesity status post LAGB placement 8-years ago presents with worsening epigastric and port site pain, prompting an EGD that revealed erosion of the gastric lap band through the gastric mucosa into the lumen of the proximal stomach. Multidisciplinary plan with bariatric surgery was made for endoscopic removal of the eroded gastric lap band. Initial laparoscopy transected distal band tubing and was withdrawn orally (A). Subsequent EGD discovered eroded gastric lap band in the gastric cardia. Forceps loosened the band so that wire could loop around it, allowing lithotripter to cut the band (B,C). Lap band was pulled into the gastric lumen, using cut plastic cord left from laparoscopy in the peritoneum. Using forceps, the gastric lap band and attached cord were removed from the stomach trans-orally (D). At the end of the case, the surgical team entered the peritoneum laparoscopically and performed an air leak test on the stomach/cardia, which was negative (E). Band was successfully removed without complications (F). Discussion: LAGB is a restrictive weight loss procedure approved by the FDA in 2001 for morbid obesity, in which a silicone band is placed around the proximal stomach and inflated with saline through a subcutaneous access port to create satiety and resultant weight loss. Despite decreased popularity, it still accounts for up to 3% of all annual weight loss surgical interventions. Band erosion is a late complication of LAGB, seen in 0.5-10% of patients. Risk factors for it include overfilling of the band with saline which can result in inflammation or ischemia, inflammatory foreign body reaction of the stomach, gastric wall injury during placement. Band erosion typically presents with non-specific abdominal pain, weight regain, discoloration of the fluid in the band. If infected it can present with sequelae of infection including port infection, sepsis and peritonitis. Our case obviated the need for invasive surgical removal or a specialized band cutter.[2817] Figure 1. (A) Initial laparoscopy did not show the lap band by view as it was surrounded and encased an inflammatory rind, but band tubing was seen emerging and distal tubing was transected close to the abdominal wall. (B) A Tracer Metro long wire was advanced through the gastroscope into the stomach and looped around the band itself. (C) Soehendra lithotripter was used to cut the lap band while the gastroscope was situated within the stomach (retroflexed) visualizing the cutting of the band. (D) Using r...

Lymphoma when arising from sites other than lymph nodes is termed extranodal lymphoma, commonly affecting the gastrointestinal tract. Primary colorectal lymphoma is a rare phenomenon among malignancies affecting the colon. We report a case of a patient with a history of Burkitt lymphoma in remission, presenting with a large cecal mass and a new diagnosis of diffuse large B-cell lymphoma treated with chemotherapy.