bluuebunny/crossref_metadata_2025_split huggingface dataset:
299 Obesity Is Risk Factor for Colorectal Cancer Recurrence: A Systematic Review and Meta-Analysis
Authors: Lin Kevin , Jaspan Vita , Wilder Evan , Chang Steven , Popov Violeta 
Published: October 2019

INTRODUCTION:
There is a wealth of epidemiologic evidence supporting the association between weight parameters and colorectal cancer incidence. However, how these variables affect colorectal cancer (CRC) recurrence is still a topic of debate. In our study, we hypothesized that there would be increased risk of recurrence of colorectal cancer with obesity and higher visceral fat.

METHODS:
A systematic review of electronic databases was performed through April 2019, including NCBI, Embase, Cochrane, and Web of Science. Screening was performed using Covidence and each article was screened independently by two authors. Included were retrospective and prospective studies reporting CRC outcomes of at least 2 months after cancer diagnosis. The primary outcome was CRC recurrence in obese compared to normal weight subjects, and high vs. normal visceral fat. Weight parameters tested were body mass index (BMI) categories of underweight, normal, overweight, and obese; visceral fat as measured by CT scan into categories of normal and high visceral fat. Odds ratios (OR), risk ratios (RR), and 95% confidence intervals (95% CI) are reported. Random effects analysis was performed for all outcomes, with heterogeneity assessed by the I2 statistic.

RESULTS:
484 citations were reviewed of which 9 were included in the final analysis. In total, 7 studies analyzed CRC recurrence data in terms of BMI, and 2 in terms of visceral adiposity. Most were retrospective cohort studies. These studies comprised 5777 patients, with an average age of 61.4 years and with mean follow-up time of 58.4 months, range (52 months–77 months). Both overweight and obese BMI were associated with significantly increased risk of cancer recurrence compared to normal BMI individuals (Figure 1), OR 1.41 (95% CI 1.18–1.69), P = 0.00, I2 = 0%, N = 4295, and OR 1.47 (95% CI 1.02–2.12), P = 0.04, I2 = 45%, N = 3637, respectively. There was no association between being underweight and colorectal cancer recurrence compared to normal BMI or overweight BMI. High visceral adiposity was also not associated with increased CRC recurrence, although only two studies were included in our meta-analysis (Table 1).

CONCLUSION:
Obese and overweight BMI are both associated with increased risk of CRC recurrence compared to normal weight. However, being underweight was not associated with CRC recurrence compared to being normal weight. Patients with CRC would likely benefit from active interventions to prevent obesity.
311 Colorectal Neoplasm in Patients With Cryptogenic Pyogenic Liver Abscess, Do They Need Routine Screening Colonoscopy: A Systematic Review and Meta-Analysis
Authors: Mohan Babu P. , Aravamudan Veeraraghavan Meyyur , Khan Shahab R. , Chandan Saurabh , Ponnada Suresh , Asokkumar Ravishankar , Navaneethan Udayakumar , Adler Douglas G. 
Published: October 2019

INTRODUCTION:
Patients with cryptogenic pyogenic liver abscess (PLA) do not have a definite source of infection and it could be a manifestation of compromised colonic mucosal barrier due to colorectal cancer (CRC). Association of PLA and CRC is unclear. Evidence is weak and limited to small sized studies. As a result, the need for screening colonoscopy in PLA patients is subject to debate and currently not established.

METHODS:
We conducted a comprehensive search of multiple electronic databases and conference proceedings (from inception through January 2019) to identify studies that reported on the prevalence of CRC in PLA patients. Our goal was to evaluate the pooled rate of prevalence of CRC in patients with cryptogenic PLA. Heterogeneity was measured by I2 statistics and funnel-plot was used to assess publication bias.

RESULTS:
12 studies were included in the analysis. Majority of them were from East Asian countries. 18,607 patients were diagnosed with PLA in study group and 60,130 patients were in control group. 63% were males in the age range of 56 to 94 years. 90.5% of the lesions were left sided and 93.1% were positive for Klebsiella pneumoniae. A total of 18,607 PLA patients were reported, of which 17,906 patients underwent screening colonoscopy. A total of 713 colorectal lesions were found, of which 648 were diagnosed with CRC. 60,130 patients were used as control, of which 509 patients were diagnosed with CRC. The pooled rate of prevalence of CRC was 7.9% (95% CI 5-12.1, I2 = 92.4, relative risk = 6.6) in patients with PLA, as compared to 1.2% (95% CI 0.3-5.7, I2 = 93.4) in control, with statistical significance (P = 0.001). Relative risk = 6.6. Publication bias was present.

CONCLUSION:
In conclusion, our meta-analysis demonstrates that patients with cryptogenic PLA have a 7-fold risk of having CRC, when compared to people without PLA. Although limited by heterogeneity, our results support the need for a screening colonoscopy in patients diagnosed with cryptogenic PLA, especially if positive for Klebsiella pneumoniae.
314 In Patients With an Overall Cleansing Success the 1L Polyethylene Glycol NER1006 Achieves More High-Quality Cleansed Segments per Patient Than Three Standard Bowel Preparations
Authors: Epstein Michael S. , Halonen Juha , Amlani Bharat , Hassan Cesare 
Published: October 2019

INTRODUCTION:
In pre-colonoscopy colon cleansing, the presence of removable stool is currently considered a success for reliable adenoma detection. The phase 3 trials of 1L polyethylene glycol (PEG) NER1006 (trials DAYB, MORA and NOCT) are the largest to date joint prospective study on colon cleansing quality. Split dosing with NER1006 achieved a higher or at least as high cleansing success as sodium picosulfate/magnesium citrate (SPMC), 2L PEG + ascorbate (2LPEG), or oral sulfate solution (OSS). NER1006 also improves high-quality (HQ) cleansing in whole treatment groups, but patient level benefits are unclear.

METHODS:
This post hoc analysis of DAYB, MORA and NOCT examined if NER1006 increases the number of HQ segments per patient vs SPMC, 2LPEG or OSS, and if that could improve the adenoma detection rate (ADR) or mean number of adenomas per patient (MAP). Treatment-blinded central readers used the Harefield Cleansing Scale (HCS) to assess cleansing quality. Site endoscopists detected polyps; adenomas were confirmed by histology. Patients with full HCS scoring and adenoma counts were included. In overall cleansing successes, (HCS Grades A-B; have segments with removable stool), the number of HQ segments (HCS scores 3-4; stool-free) per patient was assessed. One-sided t-tests compared treatments. Per-patient regression analyses assessed whether HQ segments per patient improves ADR (logistic; LogR) or MAP (linear; LinR), in all patients and in cleansing successes. Odds ratios or average increments are presented with 95% CI. Trend curves were plotted with data points for group means ± SD.

RESULTS:
A total of 1749 patients were included, 1471 (84%) with overall cleansing success (Figure 1). In cleansing successes, NER1006 achieved more HQ segments per patient than SPMC (1.13 ± 1.29 vs 0.76 ± 1.07; P = 0.005), 2LPEG: (2.52 ± 1.76 and 2.65 ± 1.81 vs 1.65 ± 1.71; P < 0.001 for both) and OSS (2.61 ± 1.8 vs 2.30 ± 1.81; P = 0.032). More HQ segments per patient showed positive odds for ADR in all (OR 1.09 [1.03-1.16]; Ptrend = 0.003) and successfully cleansed patients (OR 1.11 [1.04-1.18]; Ptrend = 0.001) [Figure 2]. With LinR, more HQ segments per patient increased MAP in all (average increment 0.05 [0.01-0.09]; Ptrend = 0.012) and successfully cleansed patients (average increment 0.05 [0.01-0.10]; Ptrend = 0.025) [Figure 3].

CONCLUSION:
NER1006 delivered more HQ segments per patient than SPMC, 2LPEG or OSS. More HQ segments per patient may increase ADR and MAP and thus protect patients against colorectal cancer.
321 Factors Associated With Up-to-Date Colonoscopy Use Among Puerto Ricans in New York City, 2003-2016
Authors: Ng Sandy , Xia Yuhe , Glenn Matthew , Lin Kevin , Nagpal Neha , Liang Peter S. 
Published: October 2019

INTRODUCTION:
Colorectal cancer (CRC) is a leading cause of cancer death among Hispanic Americans. Puerto Ricans are the second largest Hispanic subgroup in the United States and the largest in New York City, but little is known about predictors of CRC screening uptake in this population. We used the New York City Community Health Survey (NYCCHS), a population-based telephone survey, to investigate predictors of up-to-date colonoscopy use over time among Puerto Ricans aged ≥50 in NYC.

METHODS:
We assessed the association between sociodemographic and medical factors and up-to-date colonoscopy use (defined as colonoscopy in the last 10 years) over four time periods: 2003-2008, 2009-2012, 2013-2014, and 2015-2016. We entered age, sex, and any additional factors with P < 0.10 on univariate analysis into a multivariable model and reached the final model for each period using stepwise backward selection.

RESULTS:
On univariate analysis, factors including age ≥65, having a primary care provider, and receiving the flu shot were associated with colonoscopy use in the last 10 years. After adjusting for multiple sociodemographic and medical factors (Table 1), age ≥65 [OR 1.41 (2003-2008), OR 1.76 (2013-2014), OR 1.82 (2015-2016)] and receiving the flu shot [OR 2.14 (2003-2008), OR 1.52 (2009-2012), OR 1.95 (2013-2014), OR 1.62 (2015-2016)] were two factors positively associated with up-to-date colonoscopy use over most time periods. Those without a primary care provider [OR 0.53 (2003-2008), OR 0.38 (2013-2014)] were significantly less likely to have an up-to-date colonoscopy.

CONCLUSION:
Older age, having a primary care provider, and receiving the flu shot are independent predictors of up-to-date colonoscopy use among Puerto Ricans in NYC. Targeted interventions to improve CRC screening should be considered for Puerto Ricans aged 50-64 and those who do not have a primary care provider.
329 Quality Assessment of Appropriate Follow-Up for Positive Fecal Immunochemical Tests at a Large Federal Healthcare Facility
Authors: Sadowski Brett , Humes Ross , Tritsch Adam , Laczek Jeffrey T. , Singla Manish 
Published: October 2019

INTRODUCTION:
Annual fecal immunochemical testing (FIT)—a first tier screening test for colorectal cancer—has the potential to help achieve wider compliance with screening recommendations, including in vulnerable populations. The impact of FIT is dependent on the ability to follow up a positive test with a colonoscopy. National guidelines provide recommendations regarding targets for appropriate follow up. We sought to study practice patterns and performance of FIT follow up at our multi-level care medical center (which includes an on-site patient centered medical home).

METHODS:
The study was performed at the Department of Defenses’ largest military treatment facility with primary care and gastroenterological (GI) services located on the same campus. All FIT orders between January 2013 and December 2017 were identified through electronic test identification codes. Retrospective chart review was performed to evaluate the indication for testing, patient notification of a positive test, GI referral, and completion of colonoscopy.

RESULTS:
A total of 979 tests were ordered with 246 positive tests. The majority of patients (169, 70.2%) had appropriate follow up or an alternative explanation of a positive test (e.g. infectious colitis). 77 patients (29.8%) had inadequate follow up. 33 of 83 patients (39.7%) ages 50-75 and 69 of 198 patients ages 18-75 did not receive adequate follow. Patients without adequate follow up were offered expedited evaluation in GI.

CONCLUSION:
We found that despite being on the same campus and sharing an electronic record, patients seen in primary care clinics utilizing an opportunistic screening strategy had appropriate follow up just over 60% of the time in the screening age cohort (50/83), falling below the 80% threshold recommended by national guidelines. Due to our findings, we embarked on plans to alter the way patients with positive FIT are routed between primary care providers and GI clinic. Interventions to improve follow-up of positive FIT include expedited colonoscopy scheduling and automatic patient notification of FIT results. We have adjusted our electronic ordering system to require providers to specify an indication when ordering FIT so that patients with positive screening tests are automatically referred in a highly reliable fashion. These findings support the use of a programmatic screening program when utilizing a FIT test as a screening modality; systems must allocate resources to ensure patients with positive tests successfully navigate the medical system.
347 Successful Removal of Anal Condyloma With Endoscopic Submucosal Dissection (ESD): A Novel Indication for ESD
Authors: Gajula Prianka , Othman Mohamed 
Published: October 2019

INTRODUCTION:
Endoscopic submucosal dissection (ESD) is a novel procedure that utilizes advanced surgical techniques to remove gastrointestinal tumors without the invasive nature of surgery. While there are many advantages to this procedure, one limitation that remains is that the standardization of ESD technique is yet to be well-defined, particularly in Western nations. Here, we present a case of a patient with a 30-mm anal condyloma who had complete resection of the pre-malignant lesion through ESD.

CASE DESCRIPTION/METHODS:
A 73-year-old female presented for screening colonoscopy. She was found to have an anal lesion on exam, biopsies showed anal condyloma with low-grade dysplasia. Given the extension of the lesion to the distal rectum, the decision was to perform dissection of the anal condyloma from the anorectal canal. Initially, the lesion was marked 5-6 mm away from its border, to allow for dissection with clear margins. In the next step, a 25-gauge needle was used to inject a solution containing Hetastarch and methylene blue. This was done to raise the lesion away from the muscularis propria layer. A circumferential incision was made, beginning at the anal aspect of the lesion. To make the final dissection, a dissection knife with an insulated ceramic tip was used in the forward view. This allowed for secure separation of the lesion in one piece, without any tissue injury.

DISCUSSION:
A 30 mm anal condyloma was procured. Pathology showed an anal condyloma with anal intraepithelial neoplasia grade I (AIN1). The lesion was negative for any high-grade dysplasia or carcinoma. Peripheral and deep margins were free of the lesion. The patient had mild rectal pain for three days after the procedure, which completely resolved with the application of lidocaine gel. ESD is a highly effective resection tool and should be considered for treatment of rectal condylomatous lesions.
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352 Volumetric Laser Endomicroscopy Feature Discovery and Diagnostic Performance Optimization for Barrett’s Esophagus Dysplasia Using Laser-Targeted Biopsies With Histopathologic Correlation
Authors: Leggett Cadman , Trindade Arvind , McKinley Matthew , Chang Kenneth J. , Samarasena Jason , Singh Satish , Mashimo Hiroshi , Smith Michael S. , Béchard Vincent , Vieth Michael , Odze Robert , Tearney Gary J. , Wang Kenneth K. 
Published: October 2019

INTRODUCTION:
Volumetric laser endomicroscopy (VLE) is a high-resolution imaging modality used in Barrett’s esophagus (BE) surveillance. Established VLE scoring systems use a combination of features to guide BE dysplasia diagnosis but it remains unclear whether these features are sufficient to reach optimal VLE diagnostic performance. This study explores an exhaustive list of VLE features using one-to-one imaging to pathology correlation to develop optimal VLE diagnostic models for BE dysplasia.

METHODS:
In this prospective, multi-center (5 sites) study, patients with dysplastic BE underwent VLE with laser targeted regions of interest (ROIs), followed by standard surveillance endoscopy and biopsy directed to laser-marked sites. Histology was reviewed by two GI pathologists (MV, RO) who achieved a consensus diagnosis (gold-standard). ROIs were dysplastic if low-grade dysplasia (LGD), high-grade dysplasia (HGD) or intramucosal adenocarcinoma (IMC) was present. Two VLE experts (CLL, GJT) reviewed ROIs and corresponding endoscopic images to identify and define a set of VLE features associated with BE dysplasia. A multi-variable logistic regression model based on least absolute shrinkage and selection operator (LASSO) method was developed to determine the optimal diagnostic performance of these features. A decision tree model with high clinical usability also was developed to evaluate VLE diagnostic performance for real-time image interpretation.

RESULTS:
A total of 461 VLE ROIs with matching histology were obtained from 150 patients (Table 1). A final dataset of 55 neoplastic (LGD, 12; HGD, 24; IMC, 19) and 56 randomly selected non-dysplastic ROIs were reviewed. Twenty-eight VLE features were identified describing layering, signal intensity, surface topography, and glandular characteristics. LASSO logistic regression modeling identified 5 VLE features which when utilized optimized diagnostic performance with an area under the curve (AUC) for BE dysplasia of 0.95 (Figure 1). To improve clinical usability, a decision tree model was optimized to three levels with an AUC of 0.90 (Figure 2).

CONCLUSION:
This study represents the most comprehensive review of VLE features associated with BE dysplasia to date. The proposed high-performing diagnostic models suggest that VLE can be used efficiently and effectively to enhance BE surveillance by identifying ROIs for targeted biopsy. Further validation of the proposed VLE models will determine their clinical utility.
355 Endoscopic Submucosal Dissection vs. Endoscopic Mucosal Resection for Treatment of Barrett’s Related Superficial Esophageal Neoplasia
Authors: Mejia Perez Lady Katherine , Alaber Omar A. , Jawaid Salmaan , Chua Tiffany , Kudaravalli Praneeth , Khoshknab Milad Pourmousavi , Mehta Neal , Ngamruengphong Saowanee , Vargo John , Jang Sunguk , Dumot John , Gabr Moamen , Aihara Hiroyuki , Fukami Norio , Draganov Peter V. , Chak Amitabh , Bhatt Amit 
Published: October 2019

INTRODUCTION:
The difference in long-term outcomes of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for Barrett’s related superficial neoplasia remains unclear. We aimed to compare the rates of local and metachronous recurrence of ESD and EMR in patients with clinically staged BE-associated high-grade dysplasia (HGD) and T1a esophageal adenocarcinoma (EAC).

METHODS:
Multicenter study at six academic hospitals in the U.S. including patients who underwent ESD for BE-HGD or T1a EAC. Primary outcome was a composite of metastasis and local recurrence rate. A time-to-event analysis was performed to evaluate recurrence. A Kaplan-Meier plot was constructed, and a log-rank test was used to compare the groups. A Cox hazard ratio regression analysis was performed to identify predictors of recurrence.

RESULTS:
A total of 241 patients were included. 154 underwent EMR, while 84 underwent ESD (Table 1). ESD had higher en bloc (96% vs 33%, P < 0.0001), R0 (76% vs 54%, P = 0.0009) and curative resection rates (75% vs 32%, P < .0001) when compared to EMR. The 24-month local recurrence rate for EMR and ESD was 43% and 11%, respectively (P = 0.0007) (Figure 1). Significantly more endoscopic resection procedures were required to treat recurrence after EMR compared to after ESD (Table 1). EMR, piecemeal resection, positive margins, and non-curative resection were identified as predictors of recurrence on univariate analysis. En bloc resection remained significant after multivariate analysis (Table 2).

CONCLUSION:
This multicenter study showed that ESD results in more definitive treatment of BE-associated early neoplasia than EMR, with significant lower recurrence rates and less need for repeat endoscopic therapeutic procedures than EMR.
367 Epidemiology of Barrett’s Esophagus in Cirrhosis in the United States: A Population-Based Study
Authors: Sanghi Vedha , Saleh Mohannad Abou , Alkhayyat Motasem , Rouphael Carol , Mansoor Emad , Thota Prashanthi N. , Chak Amitabh 
Published: October 2019

INTRODUCTION:
The risk of progression of Barrett's Esophagus (BE) increases with worsening liver function. Cirrhosis has high rates of GERD, but data are limited on the prevalence of BE in cirrhosis. We aimed to study the epidemiology of BE in cirrhosis and the underlying associations

METHODS:
We queried a commercial database (Explorys Inc, Cleveland,OH) that contains an aggregate of electronic health record data from 26 major integrated US healthcare systems. We identified patient cohort between 2014-2019 with a Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT). Patients with BE in the absence of cirrhosis were the control group. Patients with a new diagnosis of BE after at least 1 year of cirrhosis were the study group. We performed analyses to describe age, gender and race-based distributions and potential associations

RESULTS:
Of the 36,893,970 patients in the database between 2014-2019, 208,630 (0.57%) patients with cirrhosis and 179,610 (0.49%) patients with BE were identified. One year after the diagnosis of cirrhosis, 1,500 (0.72%) patients were diagnosed with BE for the first time. When compared to patients without cirrhosis, those with cirrhosis were 1.5 times more likely to develop BE [Odds Ratio (OR) 1.5, 95% confidence interval (CI) 1.46-1.61; P < 0.0001]. The odds of developing BE in patients with cirrhosis was higher in males vs females [OR 1.4, 95% CI 1.26-1.55; P < 0.0001], African American vs Caucasians [OR 1.36, 95% CI 1.08-1.70; P < 0.0082] and young adults (age < 65years) vs elderly (age > 65years) [OR 1.43; 95% CI 1.29-1.58; P < 0.0001] as compared to patients without cirrhosis. When compared to patients without cirrhosis, patients with cirrhosis and BE were more likely to have a history of smoking, Helicobacter pylori infection, GERD, non-steroidal anti-inflammatory use, obstructive sleep apnea and be in the 6th decade of life. Body mass index carried an increased risk of developing BE in cirrhosis [ORs in Table]. Prevalence rates of BE in cirrhosis over the past 5 years is noted in Figure 1.

CONCLUSION:
Limitations-Endoscopic and histology data are unavailable. Logistic regression analysis was not performed, thus the risk of confounding bias remains. Conclusion-This is the largest study to evaluate BE in cirrhosis. We found a rising trend over the past 5 years in the prevalence of BE in cirrhosis with 1.5 times increased occurrence. This may be a true association or attributed to increased health utilization by patients with cirrhosis or increased endoscopic evaluation by physicians