bluuebunny/crossref_metadata_2025_split huggingface dataset:
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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