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Background Continuous intestinal infusion of levodopa/carbidopa intestinal gel (LCIG) for the treatment of advanced Parkinson’s Disease (PD) leads to less variability in plasma drug levels and improved symptom control. Percutaneous Gastrojejunostomy (PEG-J) tube placement has a high placement success rate; however, delayed tube malfunctions occur in approximately 58% of cases within two years. A rare complication is bezoar formation at the jejunal tube tip. Aims To present a case of bezoar formation at the jejunal tip of a PEG-J tube that caused distal migration of the tube with gastroduodenal ulceration and required surgical extraction. Methods Full chart review was conducted including clinical notes, laboratory results, radiographic imaging, endoscopy reports, and surgical reports. A relevant literature review was conducted. Results A 57-year-old male with severe PD underwent endoscopic guided PEG-J tube insertion for continuous infusion of LCIG; intestinal administration was effective for symptom control. Two years later, he noted that the gastric tube had retracted approximately 15 cm into the stoma without external manipulation of the apparatus. Attempts to externally pull the tube back into position were unsuccessful. The patient underwent Gastroscopy (EGD) with fluoroscopy. Contrast was used to confirm placement of the jejunal tip within the jejunum, but also showed migration of the gastric tip into the duodenum. A gastroscope was used to reposition the gastric tube in the stomach; the jejunal tube was visualized to be under traction. The bumper on the apparatus was re-positioned and external tape was used to further secure the apparatus and prevent migration. A month later the tube had migrated again; repeat EGD showed the jejunal tube to be under traction with some resultant ulceration of the pyloric channel and duodenal bulb where the tube had been pressing against the mucosa. The jejunal tube could not be pulled back and appeared to be fixed distally. A CT scan was obtained to assess for complications and a coiled tip was seen in the proximal jejunum. Surgical extraction of the malfunctioning tube was required. At laparotomy, the coiled tip of the feeding tube was successfully removed via enterotomy. The tube tip had coiled around itself and was encased with food materials, creating a large bezoar that was being pulled distally by peristalsis. The patient subsequently underwent insertion of a new GJ tube for ongoing administration of LCIG and has been doing well since. Conclusions Bezoar formation at the jejunal tip of LCIG PEG-J tubes is a rare complication and can lead to distal migration and traction related gastroduodenal ulceration. Surgical removal may be required. Funding Agencies None

INTRODUCTION: Colorectal cancer is the third most common cancer worldwide. Early detection of adenomatous polyps and adenocarcinoma reduces mortality. The effectiveness of colonoscopy for colorectal cancer screening is reliant on the quality of bowel preparation. Patients with inadequate bowel preparation may require repeat colonoscopy; this exposes patients to further risks while placing financial stress on individuals and healthcare systems. The purpose of this study is to assess if a patient's description of their last bowel movement, converted to a standardized score, correlates to the quality of bowel cleansing. METHODS: This is a cross-sectional study performed at two hospitals with data collected over two months. On the day of the colonoscopy, prior to the procedure, outpatients were asked by a resident physician to describe their last bowel movement. The description was converted to a standardized score: “fully solid”, assigned a score of 0; “liquid with solid pieces”, assigned a score of 1; “brown liquid”, assigned a score of 2; and “clear / yellow liquid”, assigned a score of 3. Subsequently, each patient's total and segmental Boston Bowel Preparation Scale (BBPS) score was determined and recorded by the clinician performing the colonoscopy. The nurses and clinicians performing the procedure were blinded to the patient's last bowel movement description. Data analysis using bivariate Pearson's Correlation was used to assess the strength of correlation between the patients' descriptions and BBPS scores. RESULTS: Study population characteristics: N = 121, 66 F and 55 M; mean age 56.16 with Std. Dev. of 16.12; mean total BBPS 7.74 with Std. Dev. of 1.87. Bivariate Pearson's Correlation showed a strong correlation (r = 0.738; P < 0.001) between the patients' descriptions and total BBPS score. Patients' descriptions versus segmental BBPS scores showed: a strong correlation with Left Colon BBPS (r = 0.702; P < 0.001); a moderate correlation with Transverse Colon BBPS (r = 0.632; P < 0.001); and a moderate correlation with Right Colon BBPS (r = 0.667; P < 0.001). CONCLUSION: A patient's description of their last bowel movement, converted to a standardized score, shows a strong correlation with their BBPS score. One implication of identifying a patient with inadequate bowel preparation before a colonoscopy is potentially rescheduling the procedure. Alternatively, it may be possible to provide patients with extra time and medication for colon cleansing before the colonoscopy is attempted.

Background Predicting bowel prep quality prior to colonoscopy may help improve colonoscopy prep quality by instituting adjunct measures before colonoscopy. This will in turn reduce repeat procedures, complications, and costs. Aims We determined the utility of a standardized method to obtain information from patients on the characteristics of their last bowel movement before colonoscopy by correlating the obtained information to BBPS. We compared this approach to informal/usual descriptions attained by nurses. Methods This is a cross-sectional study with data collected at two tertiary care hospitals. On the day of their colonoscopy, outpatients were asked by an assistant to describe their last bowel movement using a standardized method. The same patients had previously been asked by endoscopy nurses to describe their last bowel movement; the assistant was blind to previous descriptions. Descriptions were assigned a score (Table 1). Following colonoscopy, total and segmental BBPS scores were recorded by the gastroenterologist performing the procedure; the gastroenterologist was blind to the descriptions. Bivariate Pearson’s Correlation was used to separately assess the correlation between descriptions and BBPS. Cohen’s Kappa was used to assess agreement between the two descriptions. Results 121 patients (ages 17–86; 55% Female) with 11% BBPS&lt; 6 were included. For descriptions attained by the assistant, there was a strong correlation with total BBPS score (r = 0.738; p &lt; 0.001); correlation to segmental BBPS was moderate-to-strong (r=0.70, 0.63 and 0.67 right, transverse and left colon respectively). For descriptions attained by endoscopy nurses, there was a moderate correlation with total BBPS score (r = 0.525; p &lt; 0.001); correlation to segmental BBPS was weak-to-moderate (r=0.52, 0.49 and 0.44 right, transverse and left colon respectively). There was weak agreement (K = 0.525) between description attained by assistant and nurses. Conclusions When asked using a standardized method, a patient’s description of their last bowel movement correlates strongly with their total and segmental BBPS score; the correlation is weaker for non-standardized descriptions attained by endoscopy nurses. A standardized questionnaire, including assessing consistency, is valuable in assessing the bowel movement before colonoscopy. Funding Agencies None