bluuebunny/crossref_metadata_2025 huggingface dataset:
292 Fast Track Screening Colonoscopy Program in Colorectal Cancer Prevention
Authors: Casper Ephraim S. , Chokhavatia Sita , Pazwash Haleh , Santana-Joseph Sobeida , Ringelstein Leslie , McKenna Kathleen , Rubinoff Mitchell
Published: October 2019

INTRODUCTION:

Purpose/Specific Aims: The purpose of this study is to assess the progress of the Fast Track Screening Colonoscopy program at The Valley Hospital in Ridgewood, NJ since its launch in June 2018.

OBJECTIVES:

1. To assess if this program can be effective in a suburban hospital. 2. To assess if this program can streamline the process of getting a screening colonoscopy. 3. To assess if this program can be safely administered.

HYPOTHESES/RESEARCH QUESTION(S):

In 2015, The Valley Hospital (TVH) made a commitment to the American Cancer Society and National Colorectal Roundtable to serve as a partner in achieving its 80% Screened for Colorectal Cancer (CRC) by 2018 initiative. The 2015 Community Health Needs Assessment revealed that 40% of healthy residents in the TVH service area do not undergo CRC screening. The need for healthy patients to consult with a gastroenterologist or colorectal surgeon prior to colonoscopy was identified as one barrier. The Fast Track Screening Colonoscopy program was developed to eliminate consultation before the procedure. In this program, a Nurse Practitioner/Navigator screens patients for eligibility, schedules colonoscopy, and performs a physical assessment in the endoscopy unit immediately prior to colonoscopy.

METHODS:

This is a retrospective review of prospectively collected data from 524 patients who contacted TVH about participation in Fast Track Screening Colonoscopy, focusing on the 124 patients who actually completed the program.

RESULTS:

The program launched on June 18, 2018. As of April 29, 2019, 124 patients have undergone screening colonoscopies in the Fast Track Screening Colonoscopy program. No serious adverse events were reported.

CONCLUSION:

What have we learned/accomplished? 1. This program attracted a large number of individuals interested in screening colonoscopy. 2. This program has successfully performed 124 screening colonoscopies in our suburban hospital from June 2018 to April 2019. 3. Adenometous and hyperplastic polyps were identified in 46 patients. 4. This program has streamlined the process of getting a screening colonoscopy. 5. There were no serious adverse events. This program with a dedicated Nurse Practitioner/Navigator can be adopted to increase CRC screening. Patients with adenoma will follow-up for surveillance with the provider to whom they were assigned. Further efforts will be directed toward expanding this program.
294 A False Positive MT-DNA Stool Test—What Is Next?
Authors: Mubder Mohamad I. , Mashiana Harmeet , Dhaliwal Amaninder , Cross Chad , Dhindsa Banreet , Chandan Saurabh , Jayaraj Mahendran , Ohning Gordon
Published: October 2019

INTRODUCTION:

Stool DNA testing for colorectal screening is a noninvasive and convenient method. Multiple studies have shown a wide range of false positive (FP) results. It is unclear if a patient with FP results are at increased long-term risk of adverse effect and currently there are no specific recommendations to guide the follow up in this cohort of patients. We aimed at finding the exact FP rate that can help design future studies.

METHODS:

A systematic literature search of multiple databases for studies in colorectal screening using MT-DNA test and reporting the FP results up to December 2018 identifying a total of 8 studies were included in our meta-analysis.

RESULTS:

The studies reported a total of 16921 patients who underwent MT-DNA screening test. A total of 789 FP results was reported with an estimated pooled rate of 10%. The estimates were calculated using the random effect model. There was a significant heterogenicity of the results reported with (I2 = 95%, Q-140.5, P < 0.001). The analysis was done using metaXL (v 5.3).

CONCLUSION:

In our meta-analysis, the FP rate was 10% which represent a significant number of patients with undetermined long-term complications especially colorectal cancer event rates in the follow-up period. More randomized controlled trials and prospective studies are needed to evaluate the possible complications and to establish possible additional follow up screening guidelines for FP test results. More randomized controlled trials and prospective studies are needed to evaluate the possible complications and to establish possible additional follow up screening guidelines for FP test results.
302 Increasing Appropriate Referrals to Genetic Counseling at the Time of Endoscopy
Authors: Feuille Colin , Avila Patrick , Ko Myung S. , Goldberg Dena , Rudrapatna Vivek A. , Singh Aparajita
Published: October 2019

INTRODUCTION:

The ACG recommends an initial assessment of family history of cancer and premalignant conditions be performed for all patients evaluated in gastroenterology practices to develop a preliminary determination of risk of familial cancer predisposition. Due to the fast-paced nature of practice and a knowledge gap, providers often miss referring high-risk patients for genetic counseling. For example, less than 2% of the projected 830,000 Lynch syndrome patients in the US are aware of their mutation status. In this quality improvement project, we implemented a one-page, patient-administered survey to identify those at high risk of common hereditary cancer syndromes and facilitate appropriate referral to genetic counseling.

METHODS:

We created a four-question survey based on National Comprehensive Cancer Network (NCCN) guidelines for genetic testing for several hereditary cancer syndromes, including Lynch syndrome and Hereditary Breast and Ovarian Cancer syndrome. It was provided to all English-speaking patients presenting for outpatient endoscopy, who voluntarily completed the survey in the waiting area. Completed surveys were assessed for meeting criteria for referral for genetic testing. The survey was implemented on April 1, 2019, and we assessed its initial impact by comparing the number of positive surveys (i.e. meeting NCCN guidelines for referral to genetic counseling) over two months post-implementation (Apr-May 2019) with the number of genetic counseling referrals by gastroenterology providers at our institution over two months pre-implementation (Feb-Mar 2019).

RESULTS:

In February-March 2019, 13 genetic counseling referrals were made by gastroenterology providers at our institution. In April-May 2019, 874 surveys were completed. 330 surveys (37.8%) had responses meeting NCCN guidelines for referral for genetic counseling and a high risk of familial cancer predisposition. 481 (55%) did not meet criteria for high-risk family history, and 63 (7.2%) had indeterminate responses, requiring additional evaluation to determine risk.

CONCLUSION:

We created a simple, self-administered survey that identified a far larger number of endoscopy patients meeting NCCN criteria for genetic counseling referral than the number of referrals placed over a comparable timeframe prior to implementation. To address the large gap in appropriate genetic counseling referrals, we aim to create a sustainable workflow for referral from endoscopy, and plan to assess patient follow-through on these referrals.
303 Early-Onset Colorectal Cancer Trends and Survival
Authors: Wood Sarah J. , Webb Leigh-Ann J. , Freedy Elan
Published: October 2019

INTRODUCTION:

In the United States, colorectal cancer (CRC) is the most common malignancy of the gastrointestinal tract and third most common cancer. While incidence rates of colorectal cancer in the older population continues to decline, incidence rates in adults aged less than 50 years have been on the rise since the 1990s. The increase of CRC in this younger population is almost solely confined to the Caucasian race. In the younger population, key symptoms often go unrecognized and misdiagnoses often precede the suspicion for malignancy. Our large, retrospective study aimed to better understand the outcomes and survival horizons of young patients with CRC.

METHODS:

A population dataset for CRC cases from 2003-2015 was acquired from the NCI SEER database. Data extracted from SEER includes all CRC cancer diagnoses from 2003-2015 for patients aged less than 50 years old. There were 48,506 cases in total.The data was cleaned and merged, and subsequently analyzed by various modalities including Kaplan-Meier Survival Estimators, Cox Proportional Hazard Ratio, and Logistic Regression.

RESULTS:

From 2003-2015, 75% of all individuals diagnosed with early-onset CRC were of Caucasian race. The majority of patients at time of diagnosis were found to have high tumor burden, no metastatic disease, and moderate (grade 3) differentiation. Approximately half of the initial diagnoses were T3. Despite large tumor burden, over 70% of young adult patients were M0 and 46.8% were N0 at time of diagnosis. Collectively, 70% of tumors were either poorly or moderately differentiated. Kaplan-Meier analysis showed overall 10-year survival of those with early onset CRC a mere 57%. Unsurprisingly, hazards ratio showed that the presence and degree of metastasis, tumor burden (stage T4), poor differentiation, and elevated CEA have the highest impact on decreasing survival.

CONCLUSION:

Our retrospective study showed that most patients diagnosed with early onset CRC had high tumor burden, no metastatic disease, and moderate to poor differentiation. Despite that 70% of patients were M0 at time of diagnosis, 10-year survival is only 57%. The escalating rates of CRC in the younger population is a serious public health concern that highlights the need for appropriate, timely follow-up of symptoms. Recently, both the ACS and ACP, have amended CRC screening guidelines to those of average risk to start at age 45, which will enable earlier detection and likely better survival outcomes for those with early-onset CRC.
306 Multicenter Success Increasing Colorectal Cancer Screening at Federally Qualified Healthcare Centers (FQHCs)
Authors: Desai Koosh , Vega Kenneth J.
Published: October 2019

INTRODUCTION:

Colon cancer is the second leading cause of cancer-related death in Georgia with 1,400 annual deaths. Colon cancer incidence and mortality decreases by 61% when patients are appropriately screened using American College of Gastroenterology recommendations. While the national screening rate is 71% and the statewide rate is 68%, at Georgia’s Federally Qualified Healthcare Centers (FQHCs), which serve 494,464 underserved patients yearly, the screening rate was only 32% in 2017.

METHODS:

Between April 2018 to July 2018, two physicians with an interest in colon cancer conducted quality improvement at four FQHCs around the state in an attempt to bridge that gap in screening. The team provided educational lectures about colon cancer to providers, reviewed screening processes to identify gaps and used ACG guideline recommendations to help clinics develop a screening policy to help ensure eligible patients get screened. They also provided patient education materials such as brochures, posters, and postcards. As a federal grant requirement, FQHCs are required to report colon cancer screening rates using a federal government system called electronic Clinical Quality Improvement. Screening rates are calculated by dividing all eligible patients who have received screening by total patients eligible for screening. These rates were collected to track quality improvements.

RESULTS:

Screening rates increased at all sites 3 months post-intervention. Site 1: 41% to 48.4%; site 2: 31.6% to 37.8%, site 3: 30.5% to 38.2%, site 4: 43.9% to 46.8%.

CONCLUSION:

We demonstrate success of a physician driven program to increase colon cancer screening rates at four federally funded clinics for the underserved in Georgia. A total of 10,933 unscreened patients were at the clinics prior to the project and screening increased from a range of 2.9% to 7.7%. A multifaceted approach included the following: 1-direct provider education sessions, emphasizing ACG tier 1 screening, especially FIT tests 2- technical expertise in making process improvements 3- providing patient education resources. These low cost strategies increased screening rates. Based on the results of this study, this program should be scaled to FQHCs around the country and would be expected to improve colon cancer mortality for the nation's underserved patients.
307 Transgelin Regulates Colon Cancer Cell Invasion by Interacting With PARP1 and Activating Rho Signaling Pathway: A Bioinformatics Analysis
Authors: Lin Ying , Lew Zhen-Xian
Published: October 2019

INTRODUCTION:

Our previous studies found that Transgelin was up-regulated in node-positive colorectal cancer versus in node-negative disease. Transgelin, an actin-binding protein, is associated with the remodeling of cytoskeleton in the cytoplasm. However, we found that Transgelin had nuclear localization in colon cancer cells and gene expression profiling identified that TAGLN over-expression affected the expression of 256 downstream genes closely related to cell morphology, migration and invasion. In addition, we found that Transgelin could interact with 297 proteins by immunoprecipitation and liquid chromatography -mass spectrometry. Thus, we speculate that Transgelin may play different roles in the nucleus and the cytoplasm, which collaboratively participate in the invasion and metastasis of colon cancer cells.

METHODS:

256 downstream genes regulated by Transgelin were analyzed by bioinformatics analysis. Transgelin has been found to regulate colon cancer metastasis through specific key genes and signaling pathways. Then, by analyzing the promoter regions of these key genes, a protein has been predicted to be the transcription factor of these genes. Further, by comparing the 297 proteins that have been previously detected to potentially interact with Transgelin, we found that the predicted transcription factor fell in this pool. Finally, we verified the interaction between Transgelin and this transcription factor by immunoprecipitation and Western blotting.

RESULTS:

Over-expression of TAGLN could lead to differential expression of 184 downstream genes. By constructing the network of gene-encoded proteins, we conducted network topology analysis and identified the key genes, including CALM1, MYO1F, NCKIPSD, PLK4, RAC1, WAS and WIPF1 (Figure 1). They are mainly involved in the Rho signaling pathway which is related to oncogenesis and tumor metastasis. In addition, bioinformatics analysis (GCBI tools) showed that all of the promoter regions of the key genes had binding sites with PARP1 protein. And PARP1 also fell in the 297 proteins that have been previously detected to interact with Transgelin. Thus, PARP1 protein was selected as a potential transcription factor. Immunoprecipitation validated that PARP1 interacted with Transgelin in RKO human colon cancer cells.

CONCLUSION:

Bioinformatics analysis revealed that Transgelin may activate the Rho signaling pathway in promoting colon cancer metastasis by interacting with PARP1.
309 Changing Characteristics and Survival in Early Onset Colorectal Cancer in an Asian American County Population From 1990 to 2016
Authors: Yik Barnabas , Ho Andrew
Published: October 2019

INTRODUCTION:

The incidence of early onset colorectal cancer has been rising, but we have limited understanding of this pattern. Some groups have noticed racial disparities in survival rates, but we still have little data on ethnic differences. We sought to analyze the characteristics of early onset colorectal cancer in a county population and discovered changes in staging and survival in the Asian subgroup over time.

METHODS:

We performed a retrospective study involving all patients less than 50 years old that were newly diagnosed with colorectal cancer at a county hospital. We collected data from the hospital’s electronic medical system and existing databases from 1991 to 2016, and analyzed the demographics, staging, survival and follow up rates for patients of Asian descent. We divided the time frame into 2 equal periods (1991-2003 and 2004-2016) and performed chi-square analysis to assess for changes in colorectal cancer diagnoses between these two groups.

RESULTS:

A total of 182 patients under the age of 50 years old were diagnosed with colorectal cancer during this 26 year period. 69 patients were diagnosed from 1991-2003, of which 17 were of Asian descent. 113 patients were diagnosed from 2004-2016, of which 36 were of Asian descent. Among the Asian population, there was 1 case of Stage 2 (6%), and 16 cases of Stage III and IV (94%) in 1991-2003. Meanwhile, there were 15 cases of Stage 1 and 2 (42%), and 21 cases of Stage 3 and 4 (58%) in 2004-2016. Chi-square analysis of early (Stage 1 and 2) vs late (Stage 3 and 4) staging revealed a significantly higher proportion of early stage colorectal cancer in 2004-2016 compared to 1991-2003 (P-val 0.02). This coincides with a significantly higher 3 year-survival and follow up in 2004-2016 than in 1991-2003 (58% vs 24%, P-val 0.038). There were no significant differences in staging or survival for the non-asian population between these time periods.

CONCLUSION:

Our findings support that there is a rising incidence of early onset colorectal cancer in general, and within the Asian population. Interestingly, there is an increasing proportion of early stage colon cancer associated with a higher 3-year survival rate in the Asian population that was not found in other ethnicities. While our study is limited to one county population, our findings show the rising incidence is associated with ethnic disparities. Additional investigation into these disparities may help shed light on the driving factors behind the increasing incidence of early colon cancer.
313 1 L NER1006 Improves High-Quality Colon Cleansing and Mean Polyp Detection versus Oral Sulfate Solution and 2 L Polyethylene Glycol Plus Ascorbate
Authors: Epstein Michael S. , Halonen Juha , Amlani Bharat , Hassan Cesare
Published: October 2019

INTRODUCTION:

Interval cancers may occur due to missed neoplasia during colonoscopy. ‘Adequate’ cleansing quality permits stool presence in the colon, however high-quality (stool-free) cleansing is now known to improve polyp detection. The 1 L polyethylene glycol (PEG) NER1006 improves high-quality colon cleansing, but whether it primarily reduces stool or liquid is unknown. We characterized the segmental high-quality cleansing with NER1006 versus two comparators, and its effect on mean polyp detection per patient.

METHODS:

A post hoc analysis of two similarly designed phase 3 clinical trials NOCT and MORA examined overnight split-dosing regimens. NER1006 was compared with oral sulfate solution (OSS; NOCT) and 2 L polyethylene glycol + ascorbate (2LPEG; MORA). Treatment-blinded central readers assessed colon cleansing quality using the Harefield Cleansing Scale (HCS) with segmental scores 0-1 (failures; irremovable stool), 2 (adequate; removable stool), 3 (high-quality; clear liquid) or 4 (high-quality; liquid-free). Site endoscopists detected polyps. Patients with full segmental scoring were included. The segmental scores distribution and mean number of polyps per patient (MPP; in patients with at least 1 to 10 polyps) were analysed per treatment group. MPP was also assessed in pooled NER1006 versus pooled OSS and 2LPEG. One-sided t-tests assessed potential differences between groups.

RESULTS:

Totally 1037/1103 patients were included (94% primary analysis set = 5185 segments). NER1006 attained more stool-free segments (HCS 3) than OSS (30% [388/1275] vs 25% [331/1300]; P = 0.002) [Figure 1] or 2LPEG (28% [368/1310] vs 15% [191/1300]; P< 0.001) [Figure 2]. NER1006 attained more liquid-free segments (HCS 4) than 2LPEG (22% [285/1310] vs 17% [220/1300]; P = 0.001), and less stool-containing segments (HCS 2) than OSS (48% [612/1275] vs 53% [687/1300]; P = 0.007 or 2LPEG (49% [641/1310] vs 66% [854/1300]; P < 0.001). Pooled NER1006 showed a higher MPP than pooled OSS and 2LPEG for at least 1 (2.8 vs 2.3; P = 0.036), 2 (4.4 vs 3.5; P = 0.020), 3 (5.7 vs 4.5; P = 0.033), 4 (7.3 vs 5.8; P = 0.049), 5 (9.7 vs 6.8; P = 0.017) and 6 polyps per patient (10.9 vs 7.5; P = 0.020) [Figure 3]. In all other patients NER1006 had a numerically higher MPP per trial and when pooled.

CONCLUSION:

Finding multiple polyps in a patient is difficult. NER1006 improves high-quality cleansing over OSS or 2LPEG primarily by delivering more stool-free segments. This improved high-quality cleansing enables detection of more polyps per patient.
318 “Go Before You Go”: Interim Analysis of a Quality Improvement Project to Improve Colorectal Cancer Screening in a Safety Net Primary Care Clinic
Authors: Haghighat Shida , Shen Helen M. , Yeh Jeffrey , Cheng Marsha R. , Idos Gregory , Rubino Barbara , Suh Joanne
Published: October 2019

INTRODUCTION:

More effective strategies are needed to improve the rate of colorectal cancer (CRC) screening among safety-net populations. The Fecal Immunochemical Test (FIT), a low-cost screening tool, is the primary modality for CRC screening at our safety net hospital. Institutional data demonstrated a poor FIT return rate of 20% within 4-6 weeks. In a study assessing barriers to FIT completion, we found that survey respondents preferred completing the FIT on the same day as their clinic appointment. This key result informed the development of a same day FIT intervention of our current study. Here we present the interim results.

METHODS:

We designed and implemented an early FIT return strategy called “Go Before You Go” within the primary care clinic. Our team met with stakeholders involved with CRC screening, including clinic leadership, nursing staff, and resident physicians. Patients were encouraged to complete the FIT in-office during their primary care visit. If patients were unable to provide their sample on the same day, then they were encouraged to return the test within one week of when the test was ordered. Resident physicians and nursing staff were counseled to encourage this policy via brief didactic sessions and reminded at daily huddles and through weekly text reminders. Television monitors in the clinic waiting room displayed ads for ”Go Before You Go.”

RESULTS:

We report the frequency of FIT completion before and after the intervention. Prior to the intervention, the total number of FITs ordered from January to March 2019 was 1444. The baseline same-day FIT return rate was 5.0% (n = 72), the 1-week return rate was 11.1% (n = 160), and the 4-week return rate was 20.6% (n = 297). Interim analysis of data one month after the introduction of the intervention demonstrated an overall improvement in the FIT return rate. A total of 488 FITs were ordered in April 2019. During the intervention period, the same-day FIT return rate increased to 12.7% (n = 62), the 1-week rate was 20.1% (n = 98) and the 4-week return rate was 29.9% (n = 146).

CONCLUSION:

Interim analysis from an ongoing “Go Before You Go” strategy resulted in an overall increase in the same-day, 1-week, and 4-week FIT completion rate in a safety net primary care clinic. This innovative approach to CRC screening shows promise; the intervention is thus ongoing and FIT return rates continue to be monitored for sustained improvement.
319 Barriers to Colorectal Cancer Screening With FIT in a Safety-Net Primary Care Clinic
Authors: Haghighat Shida , Yeh Jeffrey , Shen Helen M. , Cheng Marsha R. , Rubino Barbara , Suh Joanne , Idos Gregory
Published: October 2019

INTRODUCTION:

Colorectal cancer (CRC) screening participation remains suboptimal, particularly among underserved populations. The Fecal Immunochemical Test (FIT) is the primary CRC screening test utilized in the primary care clinic at our large safety-net hospital. The clinic’s surveillance data shows that there is only a 20% FIT return rate within 4-6 weeks. To identify key barriers to FIT completion, we adopted a community-based participatory research (CBPR) approach to identify challenges to FIT completion in this safety net setting.

METHODS:

The CBPR approach included forming relationships with pertinent stakeholders including patients, resident physicians, nursing leadership, clinic directors and staff, and laboratory personnel. An eight-item survey assessing patient awareness of CRC screening and barriers to FIT completion was administered to randomly selected patients between the ages of 50-75 in the primary care clinic. A process map for FIT collection was subsequently devised after conducting interviews with the aforementioned stakeholders.

RESULTS:

The study population (n = 126) was comprised of a diverse population: 73% Hispanic (n = 93), 9% Black (n = 11), 9% White (n = 11), and 9% other races/ethnicities (n = 11). Among the cohort, 60.3% (n = 76) were up-to-date with FIT screening. 57% (n = 72) preferred Spanish when speaking to a healthcare provider. 22% (n = 27) reported not knowing the purpose of a FIT while 33% (n = 42) reported that their provider had not spoken to them about a FIT. We did not find a statistically significant difference among patients who completed and did not complete their FIT when analyzing for language barriers, lack of awareness, lack of provider communication, and understanding of instructions. When asked how the FIT could be made easier, 22% (n = 23) preferred to complete the FIT on the same day as their appointment. A discrepancy was found between the clinic-reported and patient-reported one-year FIT completion rates (60.3% vs. 76.7%, respectively). We found that the discordance was due to mislabeled/expired FITs which were discarded by the lab without notifying providers.

CONCLUSION:

By using CBPR grounded methods, the study identified potential areas of improvement to increase the FIT return rate, including proper handling of FITs and implementing a same-day FIT return policy. Interventions informed by this study are currently underway to increase same-day and same-week FIT return.
323 Age-Dependent Tolerability and Adenoma Detection With a Ready-to-Drink Low-Volume Bowel Preparation: Subgroup Analysis From a Randomized, Assessor-Blinded, Multicenter Study
Authors: Bertiger Gerald , Hookey Lawrence , Johnson Kenneth L. , Ando Masakazu , Stong Laura , Khan Nadeem , Dahdal David N.
Published: October 2019

INTRODUCTION:

Poor patient adherence to bowel preparation may lead to negative outcomes, including incomplete colonoscopy, missed lesions at colonoscopy, and need for repeat colonoscopy. Older adults (≥65 y) may be more sensitive to negative attributes associated with existing bowel preparations. Here, we present a subanalysis by age of patient tolerability, efficacy, and polyp detection with a ready-to-drink preparation of sodium picosulfate, magnesium oxide, and citric acid (SPMC oral solution).

METHODS:

A phase 3, randomized, multicenter study compared the efficacy and safety of split-dose SPMC oral solution to a powder formulation for colon cleansing in adults undergoing elective colonoscopy for screening, surveillance, or diagnosis. We present a subgroup analysis by age (< 50 y, 50-64 y, ≥65 y). Study protocol was approved by Schulman IRB (#000253). The primary efficacy endpoint was assessed by a blinded endoscopist for overall colon cleansing quality using a modified Aronchick Scale (AS). Tolerability was assessed by the Mayo Clinic Bowel Prep Tolerability Questionnaire. Safety assessments included adverse events (AEs) and laboratory evaluations. Any polyps found during the colonoscopy were removed, recorded as AEs, and sent for histological analysis. Polyp detection rate (PDR) and adenoma detection rate (ADR) were calculated as the percentage of any participants who had ≥1 polyp or adenoma, respectively (NCT03017235).

RESULTS:

Of 448 patients in the SPMC group, 71 (15.8%) were < 50 y, 253 (56.5%) were 50-64 y, and 124 (27.7%) were ≥65 y. Responders by AS (“excellent” or “good” ratings) were 91.5% of those < 50 y, 88.5% of those 50-64 y, and 83.9% of those ≥65 y (Figure 1). Greater than 97.6% of participants in any age group had < 25% of the bowel preparation remaining, and ³89% found it easy or acceptable to ingest (Figure 2). PDR and ADR increased with increasing age group (Figure 3). Select drug-related AEs previously associated with SPMC oral solution, by ascending age group, were nausea (7.0%, 3.2%, 0.8%), headache (4.2%, 2.8%, 1.6%), vomiting (2.8%, 1.2%, 0.8%), and hypermagnesemia (1.4%, 2.0%, 2.4%).

CONCLUSION:

Tolerability of SPMC oral solution increased with age group, with the majority of patients ³65 years old stating it was easy to ingest. PDR and ADR increased with age. Older adults may benefit from a bowel preparation that is more tolerable, which may improve preparation compliance, quality of colon cleansing, and adenoma detection.
331 Predictors of Colonoscopy Use Among Asian Indians in New York City, 2003-2016
Authors: Nagpal Neha , Xia Yuhe , Lin Kevin , Glenn Matthew , Ng Sandy , Liang Peter S.
Published: October 2019

INTRODUCTION:

Asian Americans have the lowest colorectal cancer screening uptake of any racial/ethnic group in the United States. Among Asian Americans, Asian Indians appear to be particularly under-screened, although data for this population is limited. Our objective was to characterize temporal trends in predictors of up-to-date colonoscopy use among Asian Indians in New York City.

METHODS:

We analyzed data from Indian participants in the 2003-2016 New York City Community Health Survey (NYCCHS), an annual telephone-based health survey. A total of 496 participants aged 50 years or older were identified during the study period. We examined 4 consecutive time periods for factors associated with up-to-date colonoscopy use (defined as a colonoscopy within the last 10 years): 2003-2008, 2009-2012, 2013-2014, and 2015-2016. Age, sex, and any other variable with P < 0.10 on univariate analysis was entered into a multivariable model; stepwise backward selection was performed to create the final model.

RESULTS:

On univariate analysis, factors associated with up-to-date colonoscopy use in at least two time periods included greater time in the US, non-Manhattan borough of residence, having received a flu shot, and age older than 65 years. Home language other than English, foreign birthplace, and not having a primary care provider were associated with decreased colonoscopy uptake. On multivariable analysis, older age, non-Manhattan borough of residence, BMI 25-29.9, higher income, and having received a flu shot were positively associated with colonoscopy use while Indian language, unemployment, and being non-diabetic were negatively associated in at least one time period. Compared to English, Indian home language was the most consistent negative predictor of colonoscopy uptake (OR 0.12-0.32 from 2003-2014).

CONCLUSION:

In a large study of Asian Indians in NYC, home language—a measure of acculturation—was the most consistent predictor of up-to-date colonoscopy use. Well-characterized predictors of screening in the general population, including education and insurance status, were not significant factors in the Indian population. These findings suggest targeted intervention for less acculturated members of the Asian Indian community may be warranted, and further research in this under-screened population is needed.
333 Identifying the Link Between Adenoma and Serrated Polyp Detection Rates and the Effect of Withdrawal Time on Both During Screening Colonoscopies
Authors: Berry Rani , Ahmed Rasha , Han James , Karnes William
Published: October 2019

INTRODUCTION:

Adenoma detection rate (ADR) and its surrogate marker, mean withdrawal time (WT) of ≥ 6 min, is the current golden metric for colonoscopy quality. Serrated polyp detection rate (SPDR) is also an important marker for CRC. Longer WTs are linked with higher ADRs. We aim to assess if there is a correlation between SPDR and ADR, and if the same link exists between WTs and SPDR, as it exists for WT on ADR.

METHODS:

Screening colonoscopies between 2012 and 2017 were evaluated. Endoscopists with < 40 colonoscopies and procedures with polyps >6 mm, and/or WTs >30 min were excluded. Data was grouped into fellow (FG) and attending (AG) groups. The bivariate association of SPDR and ADR was calculated by correlation coefficients. Statistical analysis was performed using chi-squared tests, two-sample t-tests, and ANOVA t-testing.

RESULTS:

A total of 5951 procedures performed by 51 fellows and 13 attendings were assessed. The MWT was 15.4 min, SD 4.72, average total procedure time (TT) was 28.3 min, and average ADR was 40%. WT had a strong positive correlation with ADR and TT. The average SPDR was 0.1, SD 0.056. SPDR had a positive correlation with WT and ADR. There were significant differences between FG and AG in ADR, WT, TT and in regression models between the two for TT. There was no difference in the mean SPDR between groups. SPDR had a strong positive correlation with ADR and WT in the AG. There was no significant difference between bowel prep vs. SPDR between groups.

CONCLUSION:

Our study demonstrates a strong linear relationship between WT, ADR and TT. While FG have a higher ADR compared with AG at the cost of a longer WT, how much ADR changes as WT increases is not significant. AG and FG had similar SPDRs, however, only for AG were SPDR positively correlated with longer WTs and higher ADRs. We postulate that given the increased technical difficulty in detecting sessile polyps, AG are better equipped to improve SPDRs with increased WT. Bowel prep scores had no effect on SPDR, explained by exclusion criteria including only fully completed colonoscopies, and therefore subpar prep patients were likely pre-excluded. Our study highlights the importance of expertise and training in the identification of sessile polyps, the association between high ADR and SPDR, and the positive effect of WT on SPDR. Kahi et al., identified variability in SPDR ranging from 1% to 18%, compared with much less variability seen in ADRs. As a result, our findings are worthy of validation in larger multiple center studies.
338 Factors Associated With Colonoscopy No-Show Among African Americans in an Urban Safety-Net Hospital
Authors: Kagbo-Kue Suaka , Chineke Iloabueke , Ajose Taiwo , Padooru Keerthi , Iloh Florence , Boone Kristopher , Nwagbara Chinonyelum , Uji Alexander , Navalah Chantal , Simien Melvin
Published: October 2019

INTRODUCTION:

Colorectal cancer (CRC) is the most common cancer diagnosed in the United States, and the second leading cause of cancer-related deaths. The incidence and mortality rates of CRC in the United States have steadily declined over the past 10 years however, reductions have been strikingly much slower among African Americans (AA) who continue to have the highest mortality rate and lowest survival. Counterintuitively, AA reportedly have the highest rate of colonoscopy no-show (missed appointments). This study aimed to identify patient level factors and other characteristics that predict colonoscopy no-show in an urban safety net hospital.

METHODS:

We carried out a retrospective review of 161 electronic medical records (EMR) of patients scheduled for colonoscopy over a 2-week period in January 2017. We identified AA patients’ factors associated with colonoscopy appointment status (completed or missed) by using hierarchical multimodal regression. Patient factors examined include age, sex, race, residence, insurance status, substance abuse, psychiatric illness, comorbidities, positive FIT test, previous endoscopy, personal or family history of cancer. Microsoft Excel and STATA software were used for data management and analyses. Two-sided P-value < 0.05 was considered statistically significant.

RESULTS:

Majority (88.4%) of the patients were African American, 5.5% Caucasians, 4.9% Hispanic, 1.2% are from “other” race. The mean age was 59 years (SD 8.3), AA no-show rate was 43%. 46.7% were male and 53.3% were female, 8.9% were less than 50 years while 91.1% were >/= 50 years. Most patients (81.1%) were either unemployed or retired. 40.7% are uninsured, 9% were active substance abusers and 20% had a psychiatric illness. Patients on Medicaid were less likely to no-show when compared to the uninsured (P < 0.05). Substance abusers were 5-times more likely to no-show (P < 0.05). A personal history of cancer though not statistically significant was associated with reduced likelihood of no-show (P = 0.095) (data extraction is ongoing to increase sample size).

CONCLUSION:

Among African American patients, social and behavioral determinants of health are known to result in healthcare disparities. Increasing Medicaid funding and the use of a patient navigator for patients at high risk for no-show could reduce no-show rates, improve patient outcomes and reduce waste of resources associated with high no-show rates; and contribute to eliminating healthcare disparities.
340 High Total Cholesterol Level Increases Risk of Finding Pre-Cancerous Colonic Polyps on Initial Colonoscopies
Authors: Shine Amal , Chaudhaury Dhruv , Liu Nanlong , Glick Connor , Furmanek Stephen , Krueger Kristine , McClain Craig
Published: October 2019

INTRODUCTION:

The association of dyslipidemia with colorectal cancer (CRC) and pre-cancerous (PC) colon polyps has been studied with mixed results. Some studies show that high total cholesterol levels reduce the risk of PC colon polyps. A recent study showed that cholesterol influences stem cell growth in the intestines, accelerating tumor formation. We examined the association of lipid levels and statin use with PC polyp detection on initial colonoscopies.

METHODS:

Data were collected on 3,541 patients admitted to Louisville Veterans Affairs Medical Center, and 2,629 were excluded based on specific criteria including pro-inflammatory states postulated to increase polyposis (e.g., IBD history, pre-existing malignancies) and lack of recent lipid panel data. Of 912 patients included, 313 (34%) had high total cholesterol levels (>200 mg/dL) and 369 (40%) had history of statin use. Median age was 61, 89% patients were male, and 22% were African American. Data were gathered by retrospective chart review of the patient’s active medications and lipid levels (within 6 months) at the time of initial colonoscopy. Statin use was further stratified by duration and intensity. A Poisson Regression Model was used for analysis with upper and lower bounds, and rate ratios (RR) with corresponding P-values were calculated. Statistical significance was set at P < 0.05. Age, sex, race, smoking history and NSAID use were controlled for.

RESULTS:

Our study indicates that high total cholesterol levels may be associated with increased PC polyp rates. High total cholesterol level (>200 mg/dL) was associated with a 21% increase in risk of PC polyps (n = 313, RR = 1.21, P = 0.024), irrespective of statin use. Statin use in “intensity-years” (intensity multiplied by years of use) did not increase PC polyp risk, and results were statistically insignificant (n = 369, RR = 1.01, P = 0.12). Other lipid levels did not reveal statistically significant differences in PC polyp risk.

CONCLUSION:

Despite conflicting results of earlier studies, our study shows that high total cholesterol level may be associated with increased risk of PC polyps, irrespective of statin use. Possible mechanisms include growth of intestinal stem cells, oxidative stress, colonic inflammation, and diet associated with increased total cholesterol levels. Larger studies are needed to confirm these findings, which may have future clinical implications regarding the introduction of specific diet and lipid modification strategies to reduce CRC risk.
342  An Interesting Report of Endoscopic Management of a Migrated Gastric Lap Band
Authors: Waintraub Daniel J. , Zivari Kaveh , Weinberger Jonathan , Fazio Richard M. , Berman Zoe , Sherwinter Danny , Ruggiero Maryanne , Khodorskiy Dmitriy O.
Published: October 2019

INTRODUCTION:

Laparoscopic adjustable gastric band (LAGB) placement is a commonly performed surgical weight loss procedure. Erosion of the band through the gastric wall is an uncommon albeit life-threatening complication that can present with abdominal pain and weight gain, potentially leading to peritonitis. Diagnosis is made with imaging such as computed tomography (CT) and may be managed by endoscopic or surgical intervention. We report a case of a LAGB that eroded through the gastric wall and migrated into the jejunum, managed with successful endoscopic retrieval.

CASE DESCRIPTION/METHODS:

58-year-old male with a history of class III obesity status post LAGB placement in 2008 presented with two months of abdominal pain, nausea, vomiting and weight loss. CT abdomen revealed mural thickening of gastric cardia with distal end of the gastric band tubing attached to a band in the jejunum and proximal end of tubing attached to a subcutaneous port (Figure 1). Fluoroscopy-guided enteroscopy revealed multiple mucosal ulcerations due to tracking of the displaced gastric band tubing. The tubing was noted to enter the gastric cavity at the cardia, extending into the proximal jejunum where the deflated gastric band was identified. A snare was used to pull the band into the gastric cavity. An upper endoscope was then inserted alongside the enteroscope (Figure 2). A 0.025 inch guidewire was placed around the tubing and captured with a snare. The distal end of the guidewire was then removed along with the gastroscope through the oral cavity. Both ends of the guidewire were loaded into a Sohendra rescue lithotripter which was then used to severe the lap band tubing approximately 10 cm from the point of entry into the gastric cavity. The resected band remained secure in the snare and was removed along with the enteroscope from the oral cavity (Figure 3). The subcutaneous port with residual gastric tubing was surgically removed two weeks later.

DISCUSSION:

LAGB erosion is an uncommon late complication of band placement. Endoscopic removal of an eroded band represents an important modality for the management of this complication and an important minimally-invasive alternative to surgery. While patients typically present with weight gain, our patient presented with weight loss likely due to intermittent obstruction. There are several reported cases of endoscopic retrieval. Our case highlights that endoscopic management should be considered as the initial treatment for eroded LAGB.

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346 Loop Combined Endoscopic Clip and Cyanoacrylate Injection to Treat the Severe Gastric Varices With Spleno-Renal Shunt
Authors: Zhenglin Ai , Ping Li
Published: October 2019

INTRODUCTION:

Endoscopic cyanoacrylate injection has been successfully used in the management of gastric variceal bleeding and recommended as firest line treatment in China. However, one of the most severe complications such as systemic embolism is fatal, especially for the gastric varice with a huge shunt. With the aim of reducing the risk of embolization, we here report on the use of a loop combined an endoscopic clipping prior to cyanoacrylate injection as a therapy to obstruct gastric varices with a large slpeno-renal shunt.

CASE DESCRIPTION/METHODS:

A 53-year-old woman was admitted with gastrointestinal hemorrhage a week ago, who underwent the subtotal gastrectomy and Billroth-II anstomosis because of obscure hemorrhage shock 18 years ago. Physical examination showed spleen was touched 4 cm below the rib cage. Lab test showed red blood cell, white blood cell and platelet were all decreased. Upper endoscopy revealed a large gastric fundal varix about 12 mm diameter and computed tomography (CT) scan showed a massive spleno-renal shunt and cavernous transformation of the portal vein (Figure 1). The prophylactic endoscopic therapy was performed for recurrent bleeding. According to the CT scan, we assessed the shunt direction from gastric fundal to cardia. A clip fixed on the middle of the varix as a pivot, a loop encircled the afferent branch and tightened up the loop gradully to obstruct the partial blood flow, simultaneously sucking slowly. After released the loop, a mixture (including 2 ml lauromacrogol, 1 ml cyanoacrylate and 2 ml sodium chloride solution) was injected into the circled vein to break further the blood flow. Then 3 mixtures were injected into the afferent vein and 1 mixture was injected into the efferent vein at different point separately to block thoroughly. One week later, upper endoscopy showed the gastric fundal varix were obstructed and CT showed the huge spleno-renal shunt were also breaking (Figure 2). Moreover, no systemic embolism was occurred. No bleeding was happened during the 6-week follow-up period. 3 month and a half year later, endoscopy view showed the fundal varix gradually disappeared and CT scan showed the varix solidified (Figure 3).

DISCUSSION:

In this case, we used a novel method which is a loop combained an endoscopic clipping to block the main stem of huge isolated gastric varice and cut back the cyanoacrylate injection. It suggested that this new way could operate more easier and simpler, avelliate the fatal embolism. More importantly, for patients, they can pay less cost.

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348 Endoscopic Management of a Recalcitrant Anastomotic Bile Leak After Pancreaticoduodenectomy
Authors: Li Feng , El-Hayek Kevin , Chahal Prabhleen
Published: October 2019

INTRODUCTION:

A 64-year-old female with past history of pylorus-preserving pancreaticoduodenectomy for pancreatic adenocarcinoma presented for endoscopic management of anastomotic bile leak and suspected stricture at the hepaticojejunostomy which persisted despite surgical and percutaneous intervention.

CASE DESCRIPTION/METHODS:

At the time of her surgery she was noted to have bile leakage from the new hepaticojejunostomy anastomosis, which was managed with intraoperative revision of the anastomosis and placement of a T-tube. On follow up after her surgery, she continued to have bilious drainage from her drains and was referred to interventional radiology for percutaneous transhepatic cholangiography. Cholangiogram demonstrated a significant leak from the anastomosis into a new subhepatic fluid collection. A percutaneous drainage catheter was placed. On subsequent catheter change, it was also noted that the biliary catheter was actually placed into a fluid collection adjacent to the small bowel and not across the hepaticojejunostomy. Internalization of the biliary catheter was unsuccessful as no flow of contrast from the bile duct to the jejunal limb could be identified. Her course was also complicated by episodes of cholangitis. To manage the persistent anastomotic leak, ERCP was performed. An adult colonoscope was advanced to the hepaticojejunostomy, which appeared widely patent. Contrast injection through the existing external percutaneous drain in the right hepatic duct confirmed complete distal occlusion of the duct without any contrast passage into the jejunum. Careful exam of anastomosis revealed sutures located superior to the hepaticojejunostomy. A 0.018 inch hydrophilic wire was advanced anterograde alongside the external drain under fluoroscopic guidance. This was unable to be passed into the small bowel but advancement of the wire resulted in a bulge in the mucosa seen endoscopically in the area of sutures, confirming the diagnosis of inadvertent surgical closure of right system. To gain access to the right biliary system, a choleodochojejunostomy was created using a needle knife in the area of the bulge created by the antegrade passage of wire through percutaneous tract. This allowed a 10 mm by 4 cm fully covered metal biliary stent to be deployed into the right hepatic duct across the newly created hepaticojejunostomy.

DISCUSSION:

In this case, we describe the endoscopic diagnosis and treatment of an iatrogenic biliary stricture leading to persistent anastomotic leak after pancreaticoduodectomy.

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