bluuebunny/crossref_metadata_2025_split huggingface dataset:
278 Helicobacter pylori Infection History Is Not a Risk Factor for Metachronous Advanced Adenoma: 8 Years' Follow-Up Study
Authors: Omata Fumio , Matoba Kohei , Ohmuro Akemi , Rai Fumie , Takashima Misako , Kato Akira , Kumakura Yasuhisa , Masuda Katsunori 
Published: October 2019

INTRODUCTION:
There have been several studies suggesting the association between Helicobacter pylori. (H. pylori) infection and colorectal adenoma or cancer. However, this causal relationship is still controversial. Most atrophic gastritis (AG) is caused by H. pylori infection and can be used as surrogate marker of H. pylori infection history. On the other hand, advanced adenoma (adenoma more than 10 mm or high-grade dysplasia (HGD) or villous adenoma) has been used as surrogate marker for risk evaluation of colorectal adenocarcinoma. The aim of this study was to determine the association between H. pylori infection and post-colonoscopy advanced adenoma (PCAA).

METHODS:
A retrospective cohort study was conducted in a center of preventive medicine and affiliated tertiary referral center in Tokyo, Japan. Consecutive 3104 individuals had general health check-up including esophagogastroduodenoscopy (EGD) between April 2004 and July 2014 and underwent initial diagnostic or screening colonoscopy within six months after general health check-up. The patients with history of inflammatory bowel disease or colectomy or only index colonoscopy were excluded. Baseline data included age, gender, height, weight, smoking history, index colonoscopy findings (the number of adenoma, maximum size of adenoma, HGD, villous adenoma), and EGD findings (AG). To determine the longitudinal association between baseline AG and PCAA, we calculated Kaplan-Meier estimates within eight years' horizon and performed multivariate Cox proportional hazards regression.

RESULTS:
Mean age [SD] of 3104 patients was 55 [12] years-old and 2169 patients (70%) were male. Mean BMI [SD] was 23 [3.2]. 1188 (39%) patients were diagnosed with AG. At the index colonoscopy, 1310 patients (42%) were diagnosed with colorectal adenoma. The cumulative incidence [95%CI] of PCAA at 3, and 5 years in the patients with AG was 3% [2–5], and 8% [6–10], respectively. Crude hazard ratio (HR) [95% CI] of age, male gender, body mass index, current smoking, and AG was 1.03 [1.02–1.05], 1.35 [0.9–2.03], 1.04 [0.98–1.1], 1.5 [0.98–2.27], and 1.46 [1.02–2.1]. Adjusted HR [95% CI] of age, current smoking, AG was 1.03 [1.02–1.05], 1.6 [1.04–2.5], and 1.2 [0.85–1.8], respectively.

CONCLUSION:
Older age and current smoking were significant risk factors of PCAA, but AG was not. The association between AG (H. pylori infection history) and PCAA was confounded by age and current smoking. The causal relationship between H. pylori infection and PCAA was not supported by our study.
284 Factors That Underpin the Increase in Right Colon Adenoma Detection Rate: A Pooled Analysis of Three Reports Comparing Water Exchange, Water Immersion, and Air Insufflation Colonoscopy
Authors: Leung Felix , Koo Malcolm , Jia Hui , Cadoni Sergio , Hsieh Yu-Hsi , Hu Chi-Tan , Leung Joseph 
Published: October 2019

INTRODUCTION:
Interval cancers due to missed adenomas tend to cluster in the right colon. Both water immersion (WI) and water exchange (WE) use water infusion to aid insertion. WI, which is easy to adopt at the discretion of the colonoscopist, removes water mainly during withdrawal. WE, which has evolved from WI, removes water mainly during insertion using new skills. WE, but not WI, provides insertion cleansing and improves bowel cleanliness. Reduced cleaning-related multi-tasking distractions from search for polyps, but not improved bowel cleanliness per se, is linked significantly to the improved adenoma detection rate (ADR) with WE (UEGJ Dec 5, 2018). In a pooled data analysis of three reports, WE significantly increased right colon adenoma detection rate (rADR) compared with WI and air insufflation (AI) (DDW 2019). However, the significant and independent factors that account for the increased rADR have not been described. We aim to assess the factors associated with an increase in rADR by multiple logistic regression analysis of the pooled individual patient data in the three aforementioned reports.

METHODS:
Three reports with data on rADR comparing WE with WI and AI were identified. The demographic and procedural data were extracted, pooled to optimize sample size and analyzed. Multiple logistic regression analysis was conducted using backward likelihood ratio selection procedure.

RESULTS:

Table 1 shows comparable pooled demographic data. Table 2 shows volume infused and suctioned confirm use of WE, WI and AI. WE has highest cleanliness scores, least use of adjunct maneuvers, and highest willingness to repeat. rADR of WE (22.4%) is significantly higher than those of WI (17.4%) (P = 0.009) and AI (15.7%) (P < 0.001); but WI and AI are similar (reported 2019 DDW). Table 3 shows multiple logistic regression analysis (unreported): older age, shorter insertion time, longer withdrawal time, and WE; but not WI (when compared with AI), are significant and independent factors associated with a higher rADR.

CONCLUSION:
WE, compared with AI, was significantly associated with a higher rADR, adjusting for other confounding factors. The improved quality adds value to WE colonoscopy, and justifies the call to incorporate WE into colorectal cancer prevention programs. Since WE = WI + suction of water during insertion, the higher rADR of WE provides incentive for transitioning from WI to WE. The impact of WE on right colon interval cancers warrants further assessment.
288 Multitarget Stool DNA Testing Is for Everyone: Positive Findings in Different Racial Groups
Authors: Huq Nadia , Fahed Gracia , Inaganti Anupama , Affi Aboud , Fahed Julien 
Published: October 2019

INTRODUCTION:
Different ethnic/racial groups may have unique incidences of colorectal cancer with some groups being at higher risk than others. Our study aims to look at outcomes of multitarget stool DNA testing in different racial groups.

METHODS:
There were 19400 patients who had multitarget stool DNA tests ordered. Baseline demographic traits were recorded. Of these, 1413 positive stool DNA tests followed by documented subsequent colonoscopy. A total of 12 patients with unknown racial group/ethnicity, unknown indication and findings of other carcinoma other than adenocarcinoma were excluded from analysis. Only the index lesion was recorded. Advanced adenoma was defined as an adenoma that is larger than 10 mm or had high risk features such as villous transformation or high grade dysplasia. Nonadvanced adenoma was defined as an adenoma that is smaller than 10 mm and had no high risk features. Racial/ethnic groups were divided into white/Caucasian and non-white. Statistical analysis with Chi-square was done to compare the proportions. A P-value < 0.05 was considered statistically significant.

RESULTS:
Of the patients who had multitarget stool DNA tests ordered, 206 (1.06%) were of Hispanic origin, 53 (0.27%) American Indian or Alaskan Native, 242 (1.25%) Asian, 1131 (5.83%) African American/Black, 1 (0.01%) Native Hawaiian, 5 (0.03%) Other Pacific Islander, 17416 (89.77%) Caucasian/White and 346 (1.78%) of unknown/unreported backgrounds. A total of 1401 patients were analyzed. For the white/Caucasian cohort, 1353 (75.54%) had subsequent colonoscopy compared to 97 (75.19%) of the non-white group (P = 0.93). Adenocarcinoma cases were 22 (1.68%) in white patients versus 2 (2.17%) in the nonwhite group (P = 0.67), advanced adenomas were 401 (30.68%) versus 30 (32.61%) (P = 0.70), nonadvanced adenoma was 388 (29.69%) versus 26 (28.26%) (P = 0.77), and no adenoma was 496 (37.95%) versus 34 (36.96%) (P = 0.85), respectively.

CONCLUSION:
From our study, there is no difference in colonoscopy findings from positive multitarget stool DNA tests between racial groups nor is there a difference in adherence to follow-up colonoscopy. Our study is limited by the number of patients within minority groups.
289 What Differences Are There Between Early and Delayed Colonoscopy Following a Positive Stool DNA Test?
Authors: Huq Nadia , Fahed Gracia , Inaganti Anupama , Affi Aboud , Fahed Julien 
Published: October 2019

INTRODUCTION:
Previous stool DNA studies excluded patients who had their colonoscopy done more than 3 months after a positive stool DNA test. In this study, we compare patients who had early colonoscopy with patients who had delayed colonoscopy following a positive stool DNA test.

METHODS:
Review of 1413 patients who had a positive stool DNA followed by documented colonoscopy was done. Two patients were excluded because of finding of “other carcinoma” aside from adenocarcinoma. Attention was given to the date of the colonoscopy in regards to the date of the positive stool DNA result. Patients were divided in 2 groups. Group 1 included patients who had their colonoscopy within 3 months of the positive stool DNA test while group 2 included patients who had their colonoscopy at least 3 months after the positive stool DNA test. Only the index lesion was recorded. Advanced adenoma was defined as an adenoma that is larger than 10 mm or had high risk features such as villous transformation or high grade dysplasia. Nonadvanced adenoma was defined as an adenoma that is smaller than 10 mm and had no high risk features. Statistical analysis with Chi-square and Fisher exact was done to compare the proportions. A P-value < 0.05 was considered to be statistically significant.

RESULTS:
Out of the 1411 patients included in the study, 1144 (81.08%) patients had their colonoscopy done within 3 months of the positive stool DNA results, while 267 (18.92%) had it done at least 3 months after the positive stool DNA test. Between group 1 and group 2, “adenocarcinoma” was found in 1.75% vs. 1.5% respectively (P = 1.00). “Advanced adenoma” was found in 23.25% vs. 25.47% respectively (P = 0.44). “10 mm adenoma” was found in 6.91% vs. 8.24% respectively (P = 0.45). Non advanced adenoma was found in 29.11% vs. 31.09% respectively (P = 0.52). Finally, no adenomas were found in 38.99% vs. 33.71% respectively (P = 0.11).

CONCLUSION:
This study shows similar colonoscopy outcome in patients who have positive stool DNA test whether the colonoscopy was done within 3 months or longer than 3 months after a positive stool DNA test. In future studies, it is not necessary to exclude patients who had their colonoscopy done more than 3 months after a positive DNA test.
300 Predictors of Colonoscopy Use Among Chinese Americans: An Analysis of the New York City Community Health Survey (2003–2016)
Authors: Lin Kevin , Xia Yuhe , Nagpal Neha , Glenn Matthew , Ng Sandy , Liang Peter S. 
Published: October 2019

INTRODUCTION:
Colorectal cancer (CRC) is a leading cause of cancer death among Asian Americans, who also have one of lowest rates of CRC screening. Chinese Americans are the largest Asian American subgroup in the United States (US), but there is a paucity of data examining predictors of CRC screening in this population. We used the New York City Community Health Survey (NYCCHS) to study factors associated with up-to-date colonoscopy use among Chinese Americans.

METHODS:
The NYCCHS is an annual population-based telephone survey. For this analysis, we included all Chinese Americans aged ≥50 years who participated in the survey from 2003–2016. We calculated up-to-date CRC screening uptake by colonoscopy, defined as colonoscopy within the last 10 years. To evaluate sociodemographic and medical predictors of colonoscopy use over four consecutive time periods, 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:
During the study period, 2,577 Chinese Americans were surveyed and 62.4% had received a colonoscopy within 10 years. On multivariable analysis, receiving a flu shot was the only consistent positive predictor of up-to-date colonoscopy use from 2009–2016 (OR 2.06–2.36, Table 1). Individuals without a primary care provider were less likely to have received a colonoscopy from 2003–2012 (OR 0.25–0.42), and the risk estimate remained consistent but was no longer statistically significant from 2015–2016. Similarly, being born outside of the US was associated with lower colonoscopy uptake from 2009–2014 (OR 0.06–0.22). Compared to never smokers, current but not former smokers were significantly less likely to have received up-to-date colonoscopy (OR 0.37 in 2003–2008; OR 0.16 in 2013–2014). Age, sex, borough of residence, and exercise activity were not consistent predictors of up-to-date colonoscopy uptake.

CONCLUSION:
Among Chinese Americans older than age 50 living in NYC, those who had a primary care provider and received annual flu shots were most likely to be up-to-date with colonoscopy. Foreign-born Chinese Americans and current smokers were less likely to have received colonoscopy. These findings highlight the importance of primary care for CRC prevention and provide insight into the vulnerable populations within the Chinese American community.
301 Improving Colorectal Cancer (CRC) Screening by Offering Less Invasive Testing When Patients Refuse Colonoscopy: A Quality Improvement (QI) Project
Authors: Melki Gabriel , Ghrewati Moutaz , Mohamed Hadir , Kapoor Ashima , Mohamed Abdalla , Ayoub Farhan , Wu Alexander , Barham Shaker , Laham Linda , Karim Gres , Hanna Maggie , Chandran Chandra , Baddoura Walid 
Published: October 2019

INTRODUCTION:
CRC is the third leading cause of cancer death, and therefore early detection by screening is beneficial. Residents in primary care clinics offer screening modalities for CRC starting at the age of 50. At a clinic in New Jersey, the primary method offered for screening has always been colonoscopy every 10 years starting at the age of 50. However, when patients refused colonoscopy, other less invasive tests were not being offered. A QI project was undertaken to assess the % of residents not offering less invasive tests, before and 6 months after education about CRC screening modalities.

METHODS:
63 residents were surveyed about their preferred and alternate method of CRC screening. The questionnaire was anonymous. When colonoscopy was refused, results were obtained to assess the % of residents offering less invasive tests before and 6 months after being educated about CRC screening options.

RESULTS:
At this institution, results revealed that 73% of residents offered colonoscopy as a first test, 19% FOBT and 8% other methods. 64% of residents offered less invasive tests when colonoscopy was refused; this increased to 95% at 6 months post education, accounting for a 31% increase.

CONCLUSION:
Most cases of CRC develop from adenomatous polyps. Therefore, early detection and removal by colonoscopy reduces the risk of CRC development. Colonoscopy is the gold standard for CRC screening. However, other modalities are also approved such as yearly FOBT. It is important to offer these modalities when colonoscopy is declined. This QI project demonstrated that an educational intervention about CRC screening modalities given to residents in primary care clinics enhanced the number of patients being screened, especially in the group of patients who refused colonoscopy. In conclusion, offering more CRC screening methods yields to better medical care to our patients.
304 Increasing Incidence of Polyps Greater Than 9 mm in Young Adults Undergoing Colonoscopy: A Prospective Multi-Center Study
Authors: Yip Benjamin , Holub Jennifer , Lieberman David 
Published: October 2019

INTRODUCTION:
Colorectal cancer (CRC) is the fourth leading newly diagnosed cancer and second most common cause of cancer mortality in the United States. Young adults 40-49 years old have an increasing incidence of CRC. Recent guidelines from the American Cancer Society suggest lowering the age of CRC screening to 45 years of age based on modeling analyses. We hypothesize that rates of polyps > 9 mm would also increase before the age of 50. The aim of this study is to determine the incidence of polyps > 9 mm from 2002 to 2014 in patients under 50 years old.

METHODS:
We reviewed colonoscopy data that was prospectively collected from the Clinical Outcomes Research Initiative (CORI) from 2002 through 2014. CORI uses a computerized endoscopic procedure report generator to collect data in a national endoscopy database from a consortium of 70 adult gastrointestinal practices. We identified all patients who were 40 to 59 years old and reviewed their endoscopic data. We used a robust surrogate marker for advanced adenoma defined as polyps > 9 mm as our end point. Patient outcomes were compared using age groups 40-49, 50-54, 55-59.

RESULTS:
We identified 398672 patients who were 40 to 59 years of age who underwent colonoscopy from 2002 to 2014. Twenty two percent were less than 50 years old. There was a progressive increase in polyps greater than 9 mm for all age groups over the course of this twelve year period (Figure 1). Patients who were under 50 years of age had a rise in advanced adenoma from 4.5% to 6.3% from 2005 to 2014 (Table 1).

CONCLUSION:
From 2002 to 2014 there was an increased rate of polyps > 9 mm in all subjects undergoing colonoscopy aged 40 to 59. By 2014, rates of polyps greater than 9 mm in the 40-49 year old group were similar to the 2005 rates in the 55-59 year old group. Screening before age 50 years should be considered and further studies are needed to validate this recommendation and determine the most optimal form of screening before age 50 years.
308 Impact of Hereditary Cancer Screening in Diverse Practice Settings on Gastroenterolgy Volume
Authors: Crecelius Mary , Raney Deborah , Sharlow Joseph 
Published: October 2019

INTRODUCTION:
According to the U.S. Department of Health and Human Services, colorectal cancer is the third most common cancer in the U.S. and the second leading cause of death from cancers in both men and women. Unfortunately, in non-GI settings such as women's imaging centers, OB/GYN or Primary Care Providers, GI-related hereditary cancer risk may go undetected because specialty providers tend to implement risk assessment programs focused on their expertise. Since gastroenterology (GI) is associated with germline mutations that can also have implications in hereditary breast and ovarian cancers (HBOC), a broader risk assessment is critical to the proper management of patients in all settings.

METHODS:
This retrospective study analyzes data from the hereditary cancer risk screening program that has been implemented in the following non-GI settings: Women's Wellness, OB/GYN, Breast Surgery Clinic, and Breast Imaging. By using an automated risk assessment software which flags high-risk patients based on NCCN criteria, we looked at data for the 2018 calendar year and identified the total number of patients screened in these settings. Study metrics include the number of high-risk patients identified with GI-related cancer risk, the number of patients tested, the number of pathogenic mutations found, and the overall impact to GI volume from these risk screenings.

RESULTS:

JOURNAL/ajgast/04.03/00000434-201910001-00308/table1/v/2024-02-04T204205Z/r/image-tiff

CONCLUSION:
By screening patients outside of the GI setting for hereditary cancer risk, we were able to identify that 8% of all patients screened, a significant number, need changes to their GI care management plans. Additionally, for those patients at higher risk that underwent genetic testing, 87% of those who tested positive tested for a mutation that impacts a GI-related cancer and has major impacts to GI management. This data shows that an interdisciplinary approach is needed to fully capture high-risk GI patients, and hereditary screening needs to be done in all settings in order to maximize patient care and outcomes.
315 Can Adenoma Detection Rates Predict a Benchmark for Serrated Polyp and Advanced Adenoma Detection Rates in a Diverse Urban Population?
Authors: Dalal Shaman , Shah Aun , Twohig Patrick , Desai Aakash , Sandhu Dalbir S. 
Published: October 2019

INTRODUCTION:
Adenoma detection rate (ADR) benchmark of >25% has been shown to reduce interval colorectal cancer (CRC). Serrated polyp detection rate (SDR) and advanced adenoma detection rate (AADR) can also serve as additional benchmarks to reduce interval CRC, although a standardized benchmark for AADR and SDR doesn’t exist. Recent studies have shown correlation between ADR, SDR and AADR, but in a homogenous patient population. Our study evaluated the correlation between ADR, SDR and AADR and approximated a benchmark for SDR and AADR in a diverse urban population, while attempting to identify any patient variables affecting detection rates.

METHODS:
We reviewed screening colonoscopies performed at our midwest urban, safety-net health care system over a period of one year (2017). We calculated ADR, SDR and AADR for individual providers and established correlation using non-parametric Spearman correlation coefficients between the 3 entities. Logistic regression analysis was used to calculate predictors of adenomas, advanced adenomas and serrated polyps.

RESULTS:
Of the 3000 colonoscopies reviewed, 1488 were screening colonoscopies performed by 9 experienced staff gastroenterologists. The patient population included 48% African-Americans, 42% Caucasians, and 10% others. Median (Interquartile range) ADR of all providers was 42.5 (27-61), SDR 8.4 (3.6-23), and AADR was 2.9 (0.6-4.8). All providers had an overall ADR above 25%. There was a weak positive correlation for ADR and SDR (rho = 0.13), and ADR and AADR (rho = 0.13). Logistic regression analysis identified male gender (P < 0.01) and body mass index (P = 0.02) as predictors of adenomas, while longer withdrawal time was a significant predictor for all types of polyps. We did not find statistical significance for gender or body mass index and SDR.

CONCLUSION:
Based on our study, previously suggested benchmark SDR of 7% seems appropriate. Our AADR of 2.9 was lower than suggested AADR of >6%. Additionally, a weak positive correlation was noted between ADR and SDR, and ADR with AADR although the patient population was heterogeneous and diverse making the results more generalizable for the real world.