bluuebunny/crossref_metadata_2025 huggingface dataset:
228 Variability in Colonic Eosinophilia in 277 Consecutive Patients
Authors: Saulino David , Chandran Aswathi , Ambelil Manju , Conyers Jeffrey , Al Salihi Suhair , Ertan Atilla , DuPont Andrew , Cash Brooks D. , Younes Mamoun
Published: October 2019

INTRODUCTION:

There is no acceptable method for the histopathologic evaluation and reporting of eosinophils (Eos) in colorectal biopsies because there is no agreement among pathologists as to what constitutes an abnormal finding. This study evaluated differences in Eos count relative to known clinical and pathologic features.

METHODS:

H&E slides from 277 subjects who underwent colonoscopy with biopsies were reviewed. Eos/mm 2 were counted in the area with highest concentration then correlated with clinical and pathologic findings. Normal histology (NL) was defined as biopsy without significant histopathologic changes.

RESULTS:

There were higher numbers of Eos/mm2 in the right colon than the left colon and rectum (mean 177 vs 122, respectively P < 0.0001). In the right colon, the mean Eos/mm2 was higher with pathologic diagnosis of colitis (P < 0.001), males (204 vs 164, P = 0.022), abnormal endoscopy (208 vs 148, P < 0.001), and ulcerative colitis (UC) (226 vs 158, P < 0.001), but lower with history of abdominal pain (158 vs 208, P = 0.003) and IBS-D (130 vs 185, P = 0.023). In the left colon and rectum, mean Eos/mm2 was higher with pathologic diagnosis of colitis (P < 0.001), males (154 vs 107, P < 0.001), abnormal endoscopy (155 vs 92, P < 0.001), and a diagnosis of UC (192 vs 95, P < 0.001) but lower with history of abdominal pain (108 vs 145, P = 0.003) and IBS-D (83 vs 128, P = 0.010). In NL biopsies, the right colon showed higher mean Eos/mm2 in Asians (228 vs 139, P = 0.019), and diagnosis of UC (205 vs 136, P = 0.004) but was lower with abdominal pain (132 vs 167, P = 0.028), and did not show significant differences with history of IBS-D, Chron's disease (CD), or abnormal endoscopy. In the left colon and rectum the mean Eos/mm2 with higher in males (102 vs 77, P = 0.036), and a diagnosis of CD (117 vs 78, P = 0.007) but did not show significant differences with history of UC, abdominal pain, IBS-D, or abnormal endoscopy.

CONCLUSION:

The mean number of Eos/mm2 in colorectal biopsies varies significantly by location, associated histopathologic changes, and clinical diagnosis, and is also influenced by sex. Of particular interest is the association between high Eos/mm2 in right colon biopsies with otherwise normal histology and diagnosis of UC and in left colon and rectum biopsies with history of CD. Additional larger studies are needed to define the significance of colorectal eosinophil counts in clinical practice.
231 Low Prevalence of Gastric and Duodenal Neoplasia in Patients With Colon Polyposis of Unknown Etiology
Authors: Farah Filsan , Kruger Andrew , Pearlman Rachel , Hampel Heather , Hinton Alice , Stanich Peter P.
Published: October 2019

INTRODUCTION:

Patients with ≥10 cumulative colorectal adenomas without identified APC or MUTYH mutations are labeled as colon polyposis of unknown etiology (CPUE). Two small series of CPUE patients compiled prior to widespread multi-gene panel genetic testing indicate that duodenal screening of CPUE patients may be high yield, but this has not been incorporated into guidelines. Our aim was to investigate the prevalence of neoplastic lesions on screening upper endoscopy (EGD) in CPUE patients.

METHODS:

Retrospective review of patients followed in the Hereditary and High-Risk GI Clinic for CPUE from 8/2014 through 3/2019 was performed. Inclusion criteria included age ≥18 years, ≥10 cumulative colorectal adenomas, unrevealing genetic testing including at least APC and MUTYH and receiving screening EGD (baseline EGD with ampullary visualization was a standard recommendation after the diagnosis of CPUE). Exclusion criteria included pathogenic genetic mutation in a hereditary cancer gene, history of gastric or duodenal neoplasia, serrated polyposis syndrome or a history of abdominal radiation or chemotherapy.

RESULTS:

Study criteria were met by 46 patients (31 M/15 F) with median age of 67 (range 30–82). The median cumulative adenoma count was 24 (range 10–290), with 17 (37%) having 10–19 adenomas, 26 (57%) with 20–99 and 3 (7%) with ≥100. A history of colorectal cancer was noted in 6 patients (13%) and 8 (17%) had colectomy (2 partial, 4 subtotal, 2 total). Multi-gene panel testing was performed in 42 patients (91%), with variants of uncertain significance in polyposis genes for 6 patients (13%). Screening EGD included ampullary visualization in all but 1 patient. Neoplastic findings were found in 2 patients (4%), with 1 patient with gastric adenocarcinoma at age 55 and 1 patient with ampullary adenoma at age 55. No gastric or duodenal adenomas were identified in the cohort. In the subset of patients ≤60 years, the prevalence of neoplastic findings was 13% (2/16). In the subset of patients with ≥20 adenomas, the prevalence was 7% (2/29). Further EGD after index procedure was performed in 16 patients during study period without identification of additional neoplasia.

CONCLUSION:

There was a lower prevalence of gastric and duodenal neoplasia in patients with CPUE that primarily received multi-gene panel testing than previously reported, although there may be higher yield in screening younger patients. A large, multi-center study is needed to clarify the optimal management of CPUE patients.
239 Detection Rate of Serrated Adenomas in the Screening Colonoscopy Population
Authors: Ali Birmaji , Fahim Peter , Steinbrunner Jenni , Kindel Robert
Published: October 2019

INTRODUCTION:

Colorectal cancers arise from 3 distinct pathways: the adenoma to carcinoma pathway, the Lynch syndrome pathway, and the serrated pathway. The serrated pathway is characterized by neoplastic transformation of serrated polyps, which are classified into hyperplastic polyps (HP), sessile serrated adenomas (SSA) and traditional serrated adenomas (TSA). HPs distal to descending colon have no malignant potential, while SSA & TSA are precancerous lesions. SSA are the major precursor lesions responsible of cancer via serrated pathway. SSA are difficult to differentiate histologically from HPs in the proximal colon. Recent studies have shown SSAs to be more common than previously believed. Our study purpose is to determine the prevalence of SSAs, variability amongst endoscopists in detecting serrated adenomas, and the identification of significant risk factors.

METHODS:

Patients undergoing screening colonoscopy were enrolled into this prospective cross-sectional study conducted at a tertiary community teaching hospital and an outpatient endoscopy unit. Screening colonoscopy was defined as the first colonoscopy performed in an asymptomatic patient without risk factors between the age of 50 and 80. Patients reported as having poor bowel preparation were excluded from the study. Statistical analysis was conducted to determine the overall detection rate of serrated adenomas and assess the variability among 6 endoscopists.

RESULTS:

Of the 263 screening colonoscopies, the serrated adenoma detection rate was 12.2% (95% CI 8.2–16.2%) with a wide range of variability amongst the 6 endoscopists from 3.4–15%. The total serrated polyp detection rate, which includes SSA, TSA and proximal HPs, was 13.7% (95% CI 9.5–17.9%) with a range of 10.2–17.5% amongst endoscopist. The adenoma detection rate for the endoscopists was 46.4% (95% CI 40.4–52.4%). Study results revealed serrated polyps have a significant association with Caucasians (P = 0.002), while adenomatous polyps are significantly associated with males (P = 0.001) and current smokers (P = 0.01).

CONCLUSION:

The increasing prevalence of SSA found in recent studies seems directly related to improving histologic distinction between SSA and HPs. Despite this improvement, the reported prevalence is still highly variable. Our study found that by using a total serrated polyp detection rate we were able to reduce variability amongst endoscopists, and a significant association between Caucasians and development of serrated polyps.
242 Demographic and Historical Risk Factors Associated With Incomplete, Missed, and Cancelled Colonoscopies
Authors: Castillo Michael , Gonzalez Adalberto , Hussain Ishtiaq , Wadhwa Vaibhav , Schneider Alison
Published: October 2019

INTRODUCTION:

Access to colonoscopy is critical for colorectal cancer screening. Cancelled colonoscopy appointments have a major impact on overall healthcare costs, provider workflow, and delays in colorectal cancer screening and diagnosis. We aimed to discover individual and systemic factors associated with the occurrence of incomplete, missed or cancelled colonoscopy appointments at our institution.

METHODS:

This was a retrospective observational study using the Cleveland Clinic Florida database. Patients scheduled for screening or diagnostic colonoscopy from January to June 2018 were included. There were two case groups: those that missed or cancelled colonoscopy appointments and those that had incomplete colonoscopies due to poor bowel preparation. A control group consisted of a random sample of 200 patients that had completed colonoscopies during the same time period. We excluded patients that underwent therapeutic colonoscopies. We performed descriptive analysis within each group, univariate analysis between the control group and case groups, and odds ratio. We used a 95% CI and P-values of less than 0.05 for statistical significance.

RESULTS:

4,499 colonoscopies were scheduled from January to June 2018. There were 369 (8.2%) missed/cancelled colonoscopies and 117 (2.6%) incomplete colonoscopies. Control group included a random sample of 200 completed colonoscopies. The total sample size was 686. Factors associated with a decreased risk of missed colonoscopies included white race (OR 0.56; P = 0.001), history of polyps (OR 0.52, P < 0.001), previous colonoscopy (OR 0.32; P < 0.0001), diagnosis of IBD (OR 0.21, P = 0.001), and married status (0.52; P = 0.001) (Table 1). Patients of black race (OR 2.1; P = 0.01) and patients with international addresses (OR 2.34; P = 0.04) were more likely to have incomplete colonoscopies (Table 2). Incomplete colonoscopies were more likely to be performed and re-scheduled than cancelled colonoscopies (67.5% vs. 44%; P < 0.001). Monday was the most common day for cancellations (12.6%). Difficulty understanding or tolerating bowel preparation (39.2%) was the most common reason for cancellation (Figure 1).

CONCLUSION:

Patient demographics, particularly patients visiting from international locations, were major risk factors for missed and incomplete colonoscopies. Many patients appeared to have difficulty understanding bowel preparation instructions. Future efforts should be made to focus on improving bowel preparation education. This will lead to improvement in healthcare utilization.
246 Helicobacter pylori Infection Increases the Risk of Colorectal Polyps: A Large Scale Case-Control Study
Authors: Kawahara Yoshinari , Kodama Masaaki , Mizukami Kazuhiro , Saito Tomoko , Hirashita Yuka , Sonoda Akira , Fukuda Kensuke , Matsunari Osamu , Okamoto Kazuhisa , Ogawa Ryo , Okimoto Tadayoshi , Murakami Kazunari
Published: October 2019

INTRODUCTION:

Persistent Helicobacter pylori (H. pylori) infection begins during childhood and can cause peptic ulcers and gastric cancer. It can also cause extra-gastric organ disease, including idiopathic thrombocytopenic purpura. Although some studies have indicated a correlation between H. pylori infection and the risk of colorectal neoplasms, these findings have not been consistent and are controversial. This case-control study aimed to investigate the association between H. pylori-associated endoscopic gastric mucosal atrophy (GMA) and colorectal polyp occurrence.

METHODS:

Records of 7394 participants who underwent colonoscopy examinations from August 2008 to July 2018 were reviewed retrospectively. Saved images of endoscopic examinations were used to evaluate the colorectal polyps and GMA. Adjusted odds ratios for predictors of colorectal polyps were computed by using the multiple logistic regression model.

RESULTS:

A total of 2404 subjects were registered; 1565 (65.1%) were in the GMA-positive group and 1138 (47.3%) had colorectal polyps. The multivariate analysis adjusted by age, sex, smoking habits, alcohol habits, serum lipid levels, hemoglobin A1c (HbA1c), blood pressure, and body mass index indicated that patients in the GMA-positive group more frequently had colorectal polyps compared with patients in the GMA-negative group (odds ratio [OR], 3.27; 95% confidence interval [CI], 2.68–4.01; P < 0.001). An analysis of the association between GMA degree and colorectal polyp status indicated that, compared with mild GMA, severe GMA was associated with a higher risk of proximal colon polyps (OR, 1.47; 95% CI, 1.05–2.07; P = 0.024) and two or more colorectal polyps (OR, 1.80; 95% CI, 1.30–2.49; P < 0.001).

CONCLUSION:

Colonoscopy examination is useful for discovering colorectal disease, including polyps; however, the examination is more burdensome than esophagogastroduodenoscopy for patients because of the required preparation and invasiveness. This study showed H. pylori-associated GMA found during endoscopy indicated an increased risk for colorectal polyps. Moreover, it also showed severe GMA indicated risks for proximal colon polyps and multiple polyps. These results allow physicians to recommend colonoscopy examinations for specific patients.
247  Automatic Polyp Detection System: Man Versus Machine Towards a Collaborative Colonoscopy
Authors: Beard Jasna I. , Kahloon Arslan , Siersema Peter , Gross Seth , Jacob Harold
Published: October 2019

INTRODUCTION:

Missed lesions are considered a major cause of interval cancer of the colon. The new Automatic Polyp Detection System (APDS) from Magentiq Eye was developed to enhance the ability of endoscopists to detect polyps. It is designed for offline use with future real-time applications. The system uses recorded colonoscopy videos to assess endoscopist performance against the APDS. The APDS reviews the videos to generate a computerized automatic signature of polyps; a separate screen then shows the corresponding “heat map' contour of areas suspicious for presence of polyps (see Figure 1).

METHODS:

In this proof-of-concept study, the performance of the trained system was compared with a known testing database of 35 videos (each sequence approximately 30 seconds and 1000 frames). Overall, the testing database included 35,290 frames, with polyps found in the right colon (cecum and ascending colon, 10), transverse colon (5), and left colon (sigmoid and rectum, 20). Of the 35, 33 polyps were sessile and 2 were pedunculated; sizes ranged from less than 3 mm (10), 3 to 6 mm (16), 6 to 10 mm (5), and over 10 mm (4). Our goal was to define the optimal system working point in terms of sensitivity and specificity to detect polyps present in at least 3 consecutive frames. Physicians reviewed videos for polyps that were missed by the APDS and compare it with those missed by the endoscopists.

RESULTS:

The best working point of the system showed 88% sensitivity with 98.4% specificity (0.016 false positive rate). This resulted in a system polyp detection rate (SPDR) of 85.8% with 5 missed polyps. Missed lesions were found in the ascending (2), transverse (2), and descending (1) colon. All were sessile with sizes of less than 3 mm (1), 3 to 6 mm (3), 6 to 10 mm (1). The physicians missed 4 polyps found in the transverse colon (3) and descending colon (1). All polyps missed by physicians were sessile with sizes of less than 3 mm (1), 3 to 6 mm (2), and 6 to 10 mm (1). Only one polyp was missed both by the APDS and the physician.

CONCLUSION:

Given that only one polyp was missed both by the APDS and the endoscopists, the APDS demonstrated the potential to behave as a complementary tool during colonoscopy in order to alert the endoscopist to lesions that may otherwise be missed, aiming to decrease the incidence of interval colon cancers.
250 Has Endoscopic Screening for Colon and Rectal Cancer Reached an Inflection Point?
Authors: Meade Charles , Hansel Stephanie
Published: October 2019

INTRODUCTION:

There are six currently approved screening modalities for colorectal cancer (CRC) as of 2016 United States Preventative Services Task Force guidelines. We sought to model what changes in current screening practice regarding choice between endoscopic and non-endoscopic testing would have to occur to drive a significant (10%) decrease in population-wide endoscopic procedures done as a result of CRC screening.

METHODS:

Published models of endoscopic procedural rates for all six approved screening methods were integrated with National Health Interview Survey data on screening compliance and reported utilization rates of currently approved screening modalities. A simulated population of 1000 screening-naïve patients was modeled over the guideline recommended period of 25 years (age 50–75). Individuals within the model could choose endoscopic or non-endoscopic screening, but were not allowed crossover between the two groups. Positive non-endoscopic screens were referred for endoscopy and continued on endoscopic screening thereafter. Population-wide total predicted endoscopic procedures were calculated using variables reflecting current screening practices. Choice of endoscopic and non-endoscopic screening within the population was then modified to estimate the increased adoption of non-endoscopic screening that would be necessary to drive an overall 10% reduction in total CRC screening related endoscopic screening procedures.

RESULTS:

For a simulated population of 1,000 screening-eligible and screening-naïve adults, screening activity mirroring recent compliance rates and choice of modality type generates approximately 2,612 endoscopic procedures over the population's screening lifetime. If 20% more screened patients choose non-endoscopic screening relative to current rates and overall rates of screening compliance remain stable then the number of total endoscopic procedures done for CRC screening drops by 10% (2,348).

CONCLUSION:

Currently, non-endoscopic approaches to CRC screening represent <10% of screened patients. Our data shows that if a relatively small increase in utilization of non-endoscopic screening strategies occurs then a significant reduction in the number of endoscopic procedures performed for screening purposes are likely. Such a change in screening practices might be an avenue towards reducing population screening costs, justifying initial screening at a younger age, and improving access to care.
252 Patient and Provider Risk Factors for Sessile Serrated Polyp and Adenoma Detection on Screening Colonoscopy
Authors: Zhou Margaret , Krigel Anna , Lebwohl Benjamin
Published: October 2019

INTRODUCTION:

Sessile serrated polyps (SSPs) have been increasingly recognized as precursors to colorectal cancer (CRC). Unlike adenoma detection rate (ADR), there is currently no agreed-upon benchmark for SSP detection rate (SSPDR), and data on factors that impact SSP detection are limited. We aimed to identify patient, endoscopist, and procedural factors associated with SSP and adenoma detection.

METHODS:

We used a single-center electronic endoscopy database to identify all patients ages ≥50 years who underwent outpatient screening colonoscopy from January 1, 2012 to June 30, 2018. We excluded patients with a personal history of inflammatory bowel disease or colorectal neoplasia, or who underwent colonoscopy performed by a provider with fewer than 50 colonoscopies over the study period. Univariate chi-square analysis was used to determine patient, endoscopist, and procedural-related factors associated with SSP or adenoma detection on colonoscopy.

RESULTS:

We identified 10,538 unique patients who underwent colonoscopy performed by 28 endoscopists. SSPs were detected in 233 cases (2.2%), and adenomas were detected in 3,066 cases (29.1%). On univariate analysis, race and any smoking history were significantly associated with SSP detection (P = 0.044 and P = 0.054, respectively; see Table 1). Higher endoscopist ADR and greater mean withdrawal time were also associated with higher likelihood of SSP detection (P = 0.019 and P = 0.007, respectively). There was a significant trend towards increased SSP detection in colonoscopies performed in more recent years (P < 0.001). While endoscopist gender was not associated with SSP detection on univariate analysis, female endoscopists had significantly higher ADR (35.5%) compared to male endoscopists (28.2%, P < 0.001). ADR for cases with trainees present was 33.6% compared to 28.1% in cases without trainees (P < 0.001).

CONCLUSION:

In patients undergoing screening colonoscopy, SSPDR was significantly higher in procedures performed by physicians with higher ADR or greater mean withdrawal time, and in procedures performed in more recent years. Patient tobacco use history and race were also associated with SSP detection. These findings may help in establishing SSPDR as a quality metric for screening colonoscopy.
256  Lowering the PREMM5 Model Threshold to 2.5% Identified the Majority of Patients With Lynch Syndrome
Authors: Davis Christian , Harrigan Jack , Chauhan Mahak , Hejazi Reza , Buckles Daniel , Saeed Anwaar , Kennedy Kevin , Madan Rashna , Bansal Ajay
Published: October 2019

INTRODUCTION:

The Prediction Model for Gene Mutations (PREMM) is a widely used tool for predicting the probability of Lynch syndrome but the predictive power of various cutoffs for the risk scores is unclear.

METHODS:

In this retrospective, single-center study, all patients with a diagnosis of colorectal or uterine cancer between January 1, 2016 and June 30th, 2018 were included. The patients were identified using specialized text-based search of the pathology lab information systems. Additionally, the search results were tallied with the local NCI-designated cancer center database to capture all patients with colon cancer. A structured RedCap electronic database was created to systematically abstract data about demographics, location and stage of colon cancer, PREMM5 scores, genetic testing and a detailed 3-generation family pedigree. All patients underwent screening for Lynch syndrome using immunohistochemical or microsatellite instability based testing. Final diagnoses in patients with abnormal screening was based on well-established commercial assays. The yield of Lynch syndrome was compared across three categories of PREMM5 scores: <2.5%, 2.5–4.9%, ≥5%. These scores reflect pre-test probability of Lynch syndrome. Statistical comparisons were performed using ANOVA.

RESULTS:

Of a total of 737 patients with either colon or uterine cancer, the final diagnosis of Lynch syndrome was made in 2.8% (21/737). The mean age at the time of cancer diagnosis across the three PREMM categories (<2.5%, 2.5–4.9%, ≥5%) was progressively lower: 68.9 ± 9.0 vs. 54.7 ± 9.5 vs. 48.2 ± 15.2, P < 0.001. Table 1 outlines the characteristics of the three groups. Table 2 describes the performance characteristics of different cutoffs of PREMM5 criteria.

CONCLUSION:

In patients with colorectal or uterine cancers, PREMM cutoff value of 2.5% identified the majority of patients with Lynch syndrome with a modest increase in the number needed to screen. Therefore, a PREMM score of 2.5% should trigger genetic testing.
260 Exogenous Insulin and Risk of Colorectal Adenomas in Type I Diabetes
Authors: Shieh Christine , Moleski Stephanie
Published: October 2019

INTRODUCTION:

The recent update for colorectal cancer screening to begin earlier at the age of 45 reinforces the need to better risk stratify populations for screening of colorectal adenomas which are precursor lesions to tumor formation. Prior studies suggest an association between Type II diabetes and risk of colon cancer with the underlying theory that progressive insulin insensitivity in addition to insulin use leads to hyperinsulinemia which promotes colorectal carcinogenesis. There is lack of data on risk of adenomas with isolated exogenous insulin use which is reflected in Type 1 diabetes. In this single center retrospective study, we examined the adenoma detection rate in Type I diabetics to better delineate the isolated risk of exogenous insulin use on developing colon cancer.

METHODS:

Charts for Type 1 diabetic patients spanning the age of 30–80 were reviewed. Age at first colonoscopy, gender, race, BMI, smoking history, family history of colon cancer, number of polyps, insulin use, and HbA1c were collected. Age and gender matched non-diabetics were used as control. To further control for confounding factors, multivariate analysis using logistic regression was performed.

RESULTS:

As only 5% of diabetics are Type 1, our preliminary results included forty-eight Type 1 diabetics matched with respective controls who underwent colonoscopy. Multivariate analysis showed a significant difference in adenoma detection rate between control and Type 1 diabetics (33% vs 52%, P = 0.017; OR 3.25; CI 1.28–8.95). This difference was significant (P = 0.033) in both the younger age group (<60 years of age) and the older age group (60–80 years of age). Within the Type 1 diabetes group, there was no significant association between adenoma detection and HbA1c level. There was also independent association between adenoma detection and male gender (P = 0.041), increased age (P = 0.052), and positive smoking history (P = 0.098) which is consistent with previously known data.

CONCLUSION:

Our study thus far suggests that Type 1 diabetics have an increased risk of colorectal adenomas spanning a wide range of age groups and that this difference is not affected by the HbA1c level, which is a marker of insulin resistance. Having controlled for a variety of factors, our findings suggest that this increased risk of adenomas may be influenced by long-term exogenous insulin use, as Type 1 diabetics become reliant on this at an early age. These findings will be tested for validation in a larger cohort.
261 Sessile Serrated Polyp Detection Rate as a Screening Colonoscopy Quality Metric
Authors: Alomari Mohammad , Al Momani Laith , El Kurdi Bara , Khazaaleh Shrouq , Sarmini Muhammad Talal , Wadhwa Vaibhav , Thota Prashanthi N. , Sanaka Madhusudhan R.
Published: October 2019

INTRODUCTION:

Adenoma detection rate (ADR) is an established colonoscopy quality metric primarily used to prevent interval colorectal cancer (CRC). Likewise, higher sessile serrated polyp detection rates (SSPDR) were linked to reduced interval CRC. Recently, some studies suggested the use SSPDR as a quality indicator with proposed benchmarks mimicking that seen in ADR where 25% of all procedures should yield adenomas (20% for females and 30% for males). We aimed in our study to examine the utility of SSPDR as a quality metric for screening colonoscopies with proposed new target benchmarks.

METHODS:

A retrospective review of all screening colonoscopies in patients ≥50 years of age performed at our tertiary center between 2012 and 2014 was done. Average risk patients who had a complete colonoscopy with excellent, good, or adequate bowel preparation were included. Overall and segment specific ADR and SSPDR were calculated and compared using t-tests. Data is presented as mean ± standard deviation or frequency (%). The adjusted R-Squared statistic (R2) was used to test the correlation variability. The P-value corresponds to the correlation between ADR and SSPDR. All analyses were done using SAS (version 9. 4, The SAS Institute, Cary, NC) and a P-value < 0. 05 was considered statistically significant.

RESULTS:

A total of 4151 patients were included in the analysis. Average patient age was 60.0 ± 7.7 years and 53.2% were females. Colonoscopies were performed by 54 (64.3%) gastroenterologists and 30 (35.7%) non-gastroenterologists (General Surgeons = 9; Colorectal Surgeons = 21) (Table 1). Overall ADR was 26.4 ± 11.0, overall SSPDR was 19.3 ± 11.4. Overall SSPDR that corresponds to a predicted ADR of 25% was 16% (adjusted R2 = 0.16, P-value < 0.001). SSPDR in females that corresponds to an ADR of 20% was 10% (adjusted R2 = 0.11, P-value = 0.001) (Figure 1). These findings reflect a significant but poor correlation between ADR and SSPDR.

CONCLUSION:

Based on a large screening colonoscopy registry-based analysis, our results support the use of SSPDR as an ancillary rather than independent colonoscopy quality metric. The current study suggests a cut-off values of 16% for overall SSPDR and 10% for the female papulation. SSPDR above these values may be congruous with adequate serrated polyp detection rates. Further multicenter studies are needed to validate our findings.
266 “Google It:” Relationship Between Google Searches on Colon Cancer Screening Tests and State-level Screening Rates
Authors: Sutherland Bryn L. , Pribnow Kaylee , Browne Jason , Weiss Jennifer M.
Published: October 2019

INTRODUCTION:

One third of eligible adults in the United States are not up to date with colorectal cancer (CRC) screening. Improved access to information through search engines such as Google could impact health behavior. Google Trends is a publicly available tool that quantifies Google search volumes for a given timeframe, location and set of terms yielding a value up to 100 called relative search volume (RSV). The goal of this study was to examine the relationship between state-level RSVs for CRC screening modalities and screening rates.

METHODS:

Google Trends searches by CRC screening modality were conducted for 1/1/2013–12/31/2016 with the following terms: (1) “colonoscopy,” (2) “flexible sigmoidoscopy + sigmoidoscopy + flex sig,” (3) “virtual colonoscopy + CT colonography,” (4) “fecal occult blood test + FOBT + blood stool test for cancer + fecal immunochemical test + FIT,” and (5) “cologuard + stool DNA test.” State-level CRC screening rates were obtained from the 2016 Behavioral Risk Factor Surveillance System data. Correlation between state-level CRC screening rates and RSV for each modality were evaluated with Pearson correlation coefficients. States were divided into quintiles based on screening rates and multinomial logistic regression was performed on RSVs for each modality across quintiles.

RESULTS:

There was a moderately strong positive correlation between state-level CRC screening rates and RSVs for colonoscopy (r = 0.49, P < 0.001) and a weak positive correlation for Cologuard® (r = 0.37, P = 0.009). Multinomial regression showed no difference in RSVs for all modalities across the top three quintiles. However, when compared to the top quintile, states in the bottom quintile searched for colonoscopy 20% less (RRR = 0.81, P = 0.016) and the second lowest quintile were significantly less likely to search for CT colonography (RRR = 0.66, P < 0.001) and Cologuard® (RRR = 0.94, P = 0.03).

CONCLUSION:

State-level CRC screening rates correlate with Google Trends state-level RSVs for colonoscopy and Cologuard®. This may mean that states with higher screening rates are engaging adults by utilizing both invasive and non-invasive screening modalities. States in the top three quintiles for CRC screening showed relatively similar search patterns while the bottom two quintiles had significantly lower RSVs for alternatives to colonoscopy. CRC screening awareness campaigns in states with lower screening rates should include promotion and education of all available options for CRC screening.
268 Early-Onset Colorectal Cancer Annual Percent Change Incidence Analysis in 20–29 and 30–39 Year-Olds Utilizing 2000–2016 SEER 18 Data and Stratified by Histology
Authors: Montminy Eric M. , Zhou Meijiao , Maniscalco Lauren , Wu Xiao-Cheng , Abualkhair Wesal , Karlitz Jordan J.
Published: October 2019

INTRODUCTION:

SEER 9 analysis has revealed rising early-onset colorectal cancer (EOCRC) incidence. We seek to analyze SEER 18 EOCRC rates as this represents a greater percentage of the U.S. population compared to SEER 9 (28% vs. 9%). Furthermore, given evidence carcinoid (CN) rates are increasing and these tumors may potentially be broadly categorized as “colorectal cancer,” we aimed to substratify analysis by histology.

METHODS:

Age-specific CRC, colon only and rectal only incidence rates from SEER 18 (2000–2016) were generated in yearly intervals using SEER*Stat. Age 20–29 and 30–39 blocks were analyzed and Joinpoint regression was used to calculate annual percent changes (APC). Histologic categories included all CRCs, adenocarcinomas (AC), CNs and CRCs without CNs.

RESULTS:

Age 20–29 overall CRC APC was 3.39% from 2001–2013 and 14.55% from 2013–2016. Colon AC APCs (1.03% from 2000–2016) and rectal AC APCs (7.42% 2000–2006, −0.24% 2007–2016) in 20–29 year-olds were not statistically significant. However, colorectal combined ACs had a statistically significant, modest APC of 1.12%. In contrast, 2007–2016 age 20–29 colon CN APC was 41.05%. Rectal CN APCs were not significantly changed. Age 30–39 overall CRC APCs were 1.58% from 2000–2010 and 4.03% from 2010–2016. Age 30–39 2000–2016 colorectal AC APCs were 1.89% with a colon AC APC of 1.59% and rectal AC APC of 2.40%. Age 30–39 colonic CN APCs were 32.81% from 2010–2016. Rectal CN APCs were 2.90% from 2000–2016.

CONCLUSION:

Age 20–29 overall CRC rate increases in SEER 18 appear to be driven in large part by increasing CN incidence. Although there was a significant colorectal AC APC of 1.12% in 20–29 year-olds, there was no significant APC increase in colon ACs. There appeared to be an increased APC trend in rectal ACs from 2000–2006 (7.42%), however this was non-significant and there was a negative trend from 2006–2016. In contrast, colon and rectal ACs in the 30–39 age group have been steadily increasing. In both age groups, colon CNs have been increasing faster than rectal CNs. Reasons are unclear but could potentially represent increased use of colonoscopy which can detect proximal lesions. Study limitations include underreported age 20–29 CN rates from 2000–2006. Overall, findings support rises in CRC incidence in young adults, however this is less from ACs in 20–29 year-olds. Despite these findings, ACs are still present in 20–29 year-olds and concerning symptoms should trigger diagnostic evaluations.
269 Colorectal Cancer Annual Percent Change Incidence Analysis in 40–49 and 50–54 Year-Olds Utilizing 2000–2016 SEER 18 Data and Stratified by Histology
Authors: Montminy Eric M. , Zhou Meijiao , Maniscalco Lauren , Wu Xiao-Cheng , Abualkhair Wesal , Karlitz Jordan J.
Published: October 2019

INTRODUCTION:

SEER 9 analysis has revealed rising incidence of early-onset colorectal cancer (EOCRC) in 40–49 year-olds and within 50–54 year-olds. We seek to analyze SEER 18 EOCRC rates as this represents a greater percentage of the U.S. population compared to SEER 9 (28% vs. 9%). Furthermore, given evidence carcinoid (CN) rates are increasing and these tumors may potentially be broadly categorized as “colorectal cancer,” we aimed to sub-stratify analysis by histology.

METHODS:

Age-specific CRC, colon only and rectal only incidence rates from SEER 18 (2000–2016) were generated in yearly intervals using SEER*Stat. Age 40–49 and 50–54 blocks were analyzed, and Joinpoint regression was used to calculate annual percent changes (APC). Histologic categories included all CRCs, adenocarcinomas (AC), CNs, and CRCs without CNs.

RESULTS:

Age 40–49 overall CRC APC was 1.45% from 2000–2016. Colon AC APC was 1.08% from 2000–2016, and rectal AC APC was 1.49% 2000–2016. Age 50–54 overall CRC APCs was 1.06% from 2000–2016. Age 50–54 2000–2016 CRC AC APCs was 0.55% with a colon AC APC of 0.27% and rectal AC APC of 1.09%. Age 40–49 CRC CN APC was 4.58% from 2000–2016. Age 50–54 CRC CN APCs were 10.35% from 2000–2008, −1.09% from 2008–2012, and 9.41% from 2012–2016. All results were statistically significant except Age 50–54 colon AC APC 2000–2016 (0.27%) and Age 50–54 CRC CN APC 2008–2012 (−1.09%).

CONCLUSION:

Age 40–49 and 50–54 overall CRC rate increases in SEER 18 appear to be driven by all histology sub-types, including AC and CN. Although there was significant increase in colorectal AC APC of 0.55% in 50–54 year-olds, there was no significant APC increase in colon ACs, but significant increase in rectal ACs. In both age groups, colon and rectal CNs incidences have been increasing faster than ACs. Importantly, rising CN incidence is significantly factoring into the increase in CRC in ages 40–49 and 50–54. Reasons are unclear but could potentially represent increased use of colonoscopy which can detect proximal lesions. Overall, findings support rises in CRC incidence in EOCRC and ages 50–54. Despite these findings, ACs are still rising in 40–54 year-olds, and concerning symptoms should trigger diagnostic evaluations.
270 Telehealth-Based Colonoscopy Education May Be a Viable Alternative to In-Person Colonoscopy Education Among Veterans
Authors: Khuc Thi , Jackson Christian , Chao Daniel
Published: October 2019

INTRODUCTION:

The VA Loma Linda Healthcare System (LLVA) offers an in-person colonoscopy education class (IPCC) and a telehealth based education class to patients who live closer to outlying VA designated Community Based Outpatient Clinics (CBOCs). Anecdotally, we noticed a significant number of cancellations and no-shows for colonoscopy from patients who sought care from CBOCS. We developed a telehealth based colonoscopy class (TBCC) to be given at CBOCs. The primary aim of the study was to determine effectiveness of TBCC compared to the existing IPCC by evaluating class attendance rates, colonoscopy attendance and quality measures of colonoscopy.

METHODS:

We retrospectively reviewed records of 1429 LLVA and CBOC patients referred for colonoscopy class between April 2014 and April 2015. Patients were given the choice of attending IPCC or TBCC. The primary end points were polyp detection rate (PDR), adenomas detection rate (ADR) and adenocarcinoma detection rate (ACDR). Secondary endpoints were attendance to TBCC and IPCC and attendance to colonoscopy. Attendance was defined as the percentage of patients who complied with their first scheduled appointment. We examined the relationship between age, BMI, sex, race, and indication for colonoscopy in the IPCC and TBCC populations.

RESULTS:

TBCC attendance rate was higher than IPCC (P = 0.001). There was no significant difference in attendance to colonoscopy between TBCC and IPCC (P = 0.50). Patients receiving primary care at CBOCs more likely chose TBCC versus patients receiving primary care at LLVA who chose IPCC (92.53% vs. 24.77%, P < 0.0001). African Americans and Hispanics more likely chose IPCC, while whites more likely chose TBCC (P = 0.01). Patients with family history of colorectal cancer and bright red blood per rectum as indications for colonoscopy more likely chose IPCC (P = 0.004, P = 0.008). Sixty eight percent of colonoscopy preparations were noted to be good. There was no difference in the number of good preparations between TBCC and IPCC (94.3% and 96%, P = 0.025). ADR was higher in patients who received IPCC (44.55% and 52.17%, P = 0.02). There was no significant difference in PDR and ACDR between TBCC and IPCC groups.

CONCLUSION:

A TBCC program is a means of increasing patient attendance to colonoscopy preparation training without negatively affecting quality of colonoscopy preparation. Prospective, randomized studies on differences in adenoma detection and distance from home residence on class and colonoscopy attendance rates is needed.
273 Multi-Target DNA Aberrations in Sporadic Colorectal Cancer Tissues Do Not Differ Between Younger and Older Patients
Authors: Limburg Paul , Mahoney Douglas W. , Ahlquist David , Allawi Hatim T. , Johnson Scott , Kaiser Michael W. , Statz Sandra , Graham Rondell , Foote Patrick , Doering Karen , Burger Kelli N. , Lidgard Graham , Kisiel John
Published: October 2019

INTRODUCTION:

Colorectal cancer (CRC) screening is broadly endorsed for individuals 50–75 years of age. Given recent increases in CRC incidence and mortality for patients <50 years old, the American Cancer Society now recommends initiation of average-risk CRC screening at age 45 (Wolf AMD CA Cancer J Clin 2018). The performance of recommended tests, including the multi-target stool DNA (mt-sDNA; marketed as Cologuard™) test, has been minimally described in populations under 50 years old. To address this knowledge gap, we conducted a retrospective study of DNA markers (KRAS, BMP3, NDRG4) included in the mt-sDNA assay to quantify and compare tissue marker levels in sporadic CRC cases and normal colon controls from patients in 45–49 and 50–64 year-old age groups. Our primary hypothesis was that mt-sDNA marker levels would be statistically similar between cases in both age groups.

METHODS:

Patient samples were identified from a pathology tissue archive at Mayo Clinic, excluding those with inflammatory bowel disease or familial cancer syndromes. Formalin-fixed, paraffin-embedded tissues were reviewed by a GI pathologist for 45–49 year-old (n = 90) and 50–64 year-old (n = 96) CRC cases; normal colon samples (45–49, n = 76; 50–64, n = 92) were also included for comparison. DNA extracted from core punches was blinded and processed in a randomized order. Quantitative Allele specific Realtime Target and Signal amplification (QuARTS) assays were used to quantify KRAS mutations, and BMP3 and NDRG4 methylation. Marker level in each sample was reported as the QuARTS product of mutant KRAS, methylated BMP3 or NDRG4 relative to the ACTB product in each sample, reported as a percentage. At least 60 patients per group provided sufficient power to demonstrate differences in marker levels of ±25% between case groups and between control groups using the Wilcoxon Rank Sum test.

RESULTS:

CRC cases in the 45–49 vs 50–64 year-old groups did not differ significantly with respect to sex (P = 0.77) or race/ethnicity (P = 0.06); left-sided CRC was more common in the 45–49 vs 50–64 year-old group (87% vs. 72%; P = 0.02). None of the marker levels were statistically different between cases of the younger vs older groups or between controls of these groups (Figure 1).

CONCLUSION:

These data support the expectation of no age-related differences in CRC detection by mt-sDNA, as the relevant molecular markers, when they occur, are present at similar levels across age groups 45–49 and 50–64 years.
274 Can We Predict Low Quality Colonoscopy? Establishing Open Access Colonoscopy at a Fellow-Run Gastroenterology Clinic
Authors: Sullivan Matthew J. , Aleem Abdul , Essrani Rajesh , Hickey Patrick , Nellis Eric , Andrews Robert , Shah Hiral N. , Shah Shashin
Published: October 2019

INTRODUCTION:

Open access colonoscopy (OAC) is the process by which a patient is referred directly for colonoscopy without a pre-procedure consultative office visit. This process has been shown to decrease wait time for screening colonoscopies which can subsequently improve adherence rates. However, identifying patients at increased risk for complications or low quality colonoscopy who would benefit from a pre-procedure office visit can be difficult and no specific society guidelines exist.

METHODS:

At our fellow-run gastroenterology clinic, we retrospectively evaluated all patients who underwent screening colonoscopy during the 2016 to 2018 academic years with the aim of identifying any difference in colonoscopy quality parameters between patients deemed eligible or ineligible for OAC. The charts of all patients at average risk for colorectal cancer who were scheduled for screening colonoscopy with a fellow during the study period were reviewed. For this study, all patients were seen at an office visit prior to their procedure. We also individually evaluated our exclusion criteria for OAC.

RESULTS:

45 of 68 (66.2%) patients would have been eligible for OAC based on our current exclusion criteria. We examined 3 quality indicators for screening colonoscopy and full results are available in Table 1. Overall, there were no significant differences between the groups for bowel prep adequacy, cecal intubation rate, or adenoma detection rate (ADR). However, prep adequacy approached significance (P = 0.076). Patients taking an anticoagulant, those with NYHA class III or IV CHF, CKD4-5, or uncontrolled diabetes (A1c 8% or greater) were significantly more likely to have an inadequate bowel prep. Uncontrolled diabetes was our most frequent reason for ineligibility for OAC.

CONCLUSION:

Literature on OAC is robust, but pathways involving trainees and studies examining exclusion criteria are less prevalent. Our study demonstrated no significant differences in quality indicators for colonoscopy in patients ineligible for OAC, but did reveal significant differences in prep adequacy for certain medical conditions. Interestingly, the ADR for ineligible patients (27.3%) was higher than that for eligible patients (22.2%). Our results indicate that further investigation is required to identify patients who would benefit from a pre-colonoscopy office visit. Our exclusion criteria also require further examination to identify other potential risk factors or sub-groups at risk for low quality colonoscopy.
277  Evaluating Cancer Outcomes of Outpatient Colonoscopies in Elderly Patients Older Than 85 Years of Age
Authors: Lee Joy A. , Bi Xia , Huang Connie Y. , Coyle Walter
Published: October 2019

INTRODUCTION:

With increasing life expectancy and a growing body of aging patients, the incidence of gastrointestinal diseases including colorectal cancer increases. Currently, there are few studies on cancer outcomes of outpatient colonoscopy in patients older than 85 years of age.

METHODS:

The endoscopic database at Scripps was queried for all outpatient colonoscopies performed under moderate sedation between April 1, 2012 to March 31, 2017 on patients aged 85 years and older. Endoscopy reports were reviewed for demographics, indication for procedure, and endoscopic findings. Variables including location and stage of tumor, subsequent treatments, and overall mortality were analyzed.

RESULTS:

322 outpatient colonoscopies were reviewed. Median age was 86 years. 53% were females. Screening colonoscopies accounted for 2.1% of procedures. 40 (12.4%) colon cancers were detected. 38 (95%) were adenocarcinomas and 2 (5%) were neuroendocrine tumors. Of these, 26 (65%) were right sided colon cancers. Among patients diagnosed with cancer, anemia was the most common indication followed by positive fecal occult blood test (FOBT). 20 (50%) of these patients had a FOBT within the past year. Of those FOBTs, 18 (90%) were positive. Median age of patients with colon cancer was 88 years, with 70% females. 12 (30%) patients had never had a prior colonoscopy. Of those with colon cancer, 19 (47.5%) were diagnosed at an advanced-stage (stage III or IV). Among patients who received treatment, 32 (80%) pursued surgery, 10 (25%) received chemotherapy, and 5 (12.5%) received radiation. 3 (7.5%) patients received supportive care only. 1-year mortality was 22.5% and 3-year mortality was 40% from the time of diagnosis.

CONCLUSION:

To date, this is the first study in the United States that examines cancer outcomes in an elderly population over age 85 undergoing an outpatient colonoscopy. Overall, colonoscopies in this age group resulted in a high cancer detection rate with anemia being the most common indication for a colonoscopy. Almost half of the detected cancers were advanced-stage and prognosis was overall poor. Interestingly, FOBT may be a useful screening tool to help clinicians assess whether a colonoscopy should be pursued in the elderly population. These findings will hopefully provide clinicians guidance on screening tools and treatment options that can be offered to the growing elderly population.