bluuebunny/crossref_metadata_2025_split huggingface dataset:
224 Is Completing Advance Endoscopy Fellowship Necessary to Perform Adequate Endoscopic Mucosal Resection to Remove Large Colon Polyps?
Authors: Mouchli Mohamad , Reddy Shravani , Walsh Christopher , Mir Adil , Kesar Varun , Shakhatreh Mohammad , Chitnavis Vikas , Yeaton Paul 
Published: October 2019

INTRODUCTION:
Objective: The efficacy of Endoscopic mucosal resection (EMR) of large colon polyp could be addressed by assessing the recurrence rate, complication rates, and the number of procedures needed to eradicate the residual tissue. Aims: Assess risk factors for recurrence after EMR of large colon polyps and compare EMR efficacy between endoscopists who completed advanced endoscopy fellowship and skilled endoscopists who did not complete advance endoscopy fellowship.

METHODS:
We identified all patients with documented large colonic treated using EMR technique at Carilion Clinic, Roanoke between 01/01/2014–12/31/2017, with follow-up through 10–2018. Information on demographics, clinical and pathological features of high-risk polyps, number and timing of surveillance endoscopies, tools used during resection, and skills of performing endoscopist's were extracted. The cumulative risks of polyp recurrence after first resection using EMR technique were estimated using Kaplan-Meier curves. Risks associated with polyp recurrence were assessed using multivariate Cox proportional hazard analysis.

RESULTS:
One hundred and thirty patients (Mean age, 64.2 ± 10.7 yrs; 43.1% males) with large polyps removed using EMR (61 (46.9%) removed by advanced endoscopists (group 1) and 69 (53.1%) removed by non-advanced endoscopist (group 2)) were identified. Most of the polyp resected were located in the right colon (70.8%) and 60 (46.1%) removed in piecemeal fashion. At follow-up endoscopy, 37/130 (28.5%) developed polyp recurrence at the polypectomy site within a median of 5.5 months. The mean number of procedures needed to eradicate the residual tissue was 1.37 ± 0.64 and the resection was complicated by delayed bleeding in 6 cases (3 in each group). The median recurrence after polypectomy was not different between the two groups (1.76 yrs vs. 1.04 yrs, P = 0.26) (Figure 1). Using multivariate analysis, Prolonged withdrawal time (RR, 1.02; 95% CI, 1.003–1.027, P-value <0.01) and increased number of endoclips used to close the defect (RR, 1.2; 95% CI, 1.05–1.40, P-value <0.01) were found to be associated with high risk of polyp recurrence after resection.

CONCLUSION:
Polyp recurrence rates after EMR were not different between enodoscopists who completed advanced endoscopy training and the ones who did not. Prolonged withdrawal time and increased number of endoclips deployed to close the polypectomy defect were associated with increased risk for polyp recurrence.
235 Variable Classification of Sessile Serrated Colon Polyps Among Pathologists in an Academic Center
Authors: Abadir Alexander P. , Moosvi Zain , Karnes William 
Published: October 2019

INTRODUCTION:
Sessile serrated polyps (SSPs) are candidate precursors of most interval colorectal cancers. These mostly right-sided lesions are easily missed, often incompletely removed, and may progress rapidly to malignancy. Accurate histologic distinction between precancerous and non-precancerous polyps is key to choosing appropriate intervals for colonoscopy. Among serrated polyps (SPs), precancerous SSPs are histologically similar to non-precancerous hyperplastic polyps, and disparity among expert pathologists is high with independent reviews of the same specimens. We assessed if this discrepancy would be reflected by significant variability in classification rates of HPs and SSPs among pathologists in a real-world academic clinical setting.

METHODS:
Using our Colonoscopy Quality Database (UCICQD) at a large academic medical center, we analyzed prospectively-collected data for all polyps removed and examined between 6/2012 and 12/2016. Polyp classification rates of each pathologist were calculated; association between pathologists and polyp classifications were assessed by unconditional logistic regression for multivariate analysis. The rate of classification of each pathologist was analyzed as polyp size increased.

RESULTS:
Of 8,274 in polyps classified by 9 pathologists, 62.5% were described as adenomas. For 3,103 SPs, a mean of 22.0% was classified as SSPs. SSP classification rate varied among pathologists; a statistically significant association was found between pathologists and type of SP (HP vs SSP) (P < 0.0001). The rate increased for all pathologists with increasing polyp size, although variability was high and pathologists maintained their relative positions when comparing SSPs/SPs between polyp sizes (1–3 mm vs >4 mm), R = 0.8, P = 0.01.

CONCLUSION:
The SP classification rates of pathologists in the right colons are highly variable. The fraction of SPs classified as SSPs increases with polyp size but variability among pathologists remains high. This suggests that each pathologist is influenced by polyp size but has a different histologic threshold for distinguishing HPs and SSPs in the right colon. This data supports the idea that serrated polyps (HPs or SSPs) proximal to the sigmoid colon should be considered "surveillance relevant". This strategy will likely reduce interval cancer rates at the expense of additional colonoscopies in those with true HPs. Novel methodologies are needed to distinguish these morphologically similar but biologically distinct lesions.
238 Prevalence of Advanced Polyps at Age 45–49 Is Similar to 50–54 Years
Authors: Butterly Lynn F. , Siegel Rebecca , Robinson Christina N. , Anderson Joseph C. 
Published: October 2019

INTRODUCTION:
The American Cancer Society recommends that colorectal cancer (CRC) screening begin at 45 years. To further inform this issue, data on advanced adenoma (AA) and serrated polyp (SP) prevalence in this population are vital. We used the New Hampshire Colonoscopy Registry (NHCR) to examine age related prevalence of advanced findings in an average risk “screening” cohort <50.

METHODS:
Indications for colonoscopies in adults <50 are often diagnostic. We made the assumption that some indications (e.g., abdominal pain or constipation) might not be associated with increased risk of adenomas. To ensure an appropriate “average risk” population <50, we included only those indications expected to yield AA prevalence rates similar to screening exams, and also tested this assumption. We excluded higher-risk indications, such as GI bleeding, occult blood, Fe deficiency anemia and abnormal imaging. We also excluded surveillance exams, family history of CRC, incomplete exams and poor bowel preparation. AAs were adenomas >1 cm or with villous elements or high-grade dysplasia, or CRC. Clinically significant serrated polyps (CSSP) included large (>1 cm) SPs, any sessile SP or traditional serrated adenoma, and any proximal SP >5 mm. We present prevalence/adjusted risks for AA, adenomas and CSSP. Age was stratified into <40 (reference), 40–44, 45–49, 50–54, 55–59 and 60+ years. Covariates were sex, smoking and BMI. To test our hypothesis regarding indications, we examined the prevalence in screening versus the prevalence in included and excluded indications. We also added the presence of low-yield symptoms as a covariate.

RESULTS:
In our sample (n = 42,600), AA prevalence increased significantly at 40 yrs. The prevalence of AA and CSSP was similar for ages 45–49 and 50–54. In the model, older age was associated with significantly increased risk for AA and adenomas (Table 2). Older age effect was less pronounced in CSSPs. The prevalence of AA was 4.4% for screening, 3.2% for the included diagnoses and 5.8% for the excluded diagnoses (P < 0.001), supporting our assumption regarding indication. Low-risk symptoms were not associated with an increased risk (OR = 1.03: 0.84–1.13), further confirming our assumption.

CONCLUSION:
The prevalence of AA increased significantly in the 40–44 group as compared to those <40. The increased prevalence for both AA and CSSP at age 45–49 was similar to that for those 50–54 years. These data support the suggestion that to optimize prevention, screening should begin at 45 years.
240 Impact and Outcomes of a Weekend Screening Colonoscopy Program in a Large Health Network in Western Pennsylvania
Authors: Umar Shifa , Gladys-Oryhon Jordan , Cole Rita , Thakkar Payal , Syed Aslam , Aoun Elie , Abdul-Baki Heitham , Babich Michael , Bradley Bruce , Kulkarni Abhijit , Flannagan Renee , Goswami Raktima , El-Hachem Sandra , Lebovitz Paul J. , Dhawan Manish , Hadam Jennifer , Gomez Gustavo , Kandil Hussam , Mitre Marcia , Strahotin Cristina , Mlecko Michael L. , Gottfried Irving , Glick Kenneth , Midian Robin , Toney Rachel , Morrissey Suzanne , Gadani Akash , Chintamaneni Preethi , Appasamy Ragunath , Oliva Jose , Pfister Michelle , Deweese Dianna , Kochhar GurSimran , Manzi Susan , Parker Brian M. , Thakkar Shyam , Farah Katie 
Published: October 2019

INTRODUCTION:
Colorectal cancer screening remains underutilized with 66–67% of adults 50–75 years old being up to date with screening. The National CRC Roundtable and the ACG aimed to increase screening rates to 80% by 2018. To achieve this goal, screening colonoscopy was provided on Saturdays to improve access and provide for patients who could not take a day off of work. We evaluated the impact of improved access to colonoscopy through Saturday screenings.

METHODS:
In March 2018, Fall 2018, March 2019, colonoscopies were scheduled with 28 different providers on 12 Saturdays at 8 different sites. Patients were asked to complete a brief survey to capture demographics and reasons for choosing a Saturday for their colonoscopy. Pathology results and adenoma detection rates were collected and analyzed 1 week after procedure.

RESULTS:
220 colonoscopies were scheduled and 214 procedures performed with 6 no-show/cancellations. 207 surveys were completed. Public awareness for Saturday colonoscopies was provided through our Network hospital and healthcare insurance provider websites as well as physician practices, and social media. The mean age of participants was 55 years with the majority being Caucasian and female. Post procedure results were analyzed for the number and size of polyps, polyp pathology, and resultant surveillance intervals. Of the 207 procedures, 37.7% (n = 78) of patient has at least one adenoma. Figure 1 shows breakdown of adenoma type by number of patients. Surveillance intervals changed to 5, 3 and 1 year for 37% (n = 76), 14% (n = 30), and 3% (n = 6) of patients, respectively (Figure 2). We also found that 86% of patients were more likely to complete their colonoscopy if scheduled on a Saturday. 42% indicated that the major reason for delay in scheduling was inability to take a day off of work (Table 1).

CONCLUSION:
The impact of Saturday colonoscopies within our large Network and surrounding community is evidenced by the overwhelming response that patients would be more likely to complete their screening colonoscopy on a Saturday, if offered. The convenience of non-traditional Saturday scheduling provides substantial positive impact in our mission to improve colorectal cancer screening rates in Western Pennsylvania and to provide high quality care as well as with improved patient experience.
249 Is Stool DNA Test More Specific for Proximal or Distal Neoplasia?
Authors: Inaganti Anupama , Fahed Julien , Fahed Gracia , Huq Nadia , Affi Aboud 
Published: October 2019

INTRODUCTION:
A handful of studies evaluated stool DNA test as a screening method but there is little to no data on the location of the “positive findings” detected on subsequent colonoscopy. In our study, we performed a retrospective analysis on location of adenoma in patients with positive stool DNA test.

METHODS:
A retrospective chart review of 459 patients who had a positive stool DNA followed by “positive findings” on subsequent colonoscopy was performed. “Positive findings” was defined as finding of cancerous or advanced precancerous lesions. Only the location of the index lesion was recorded. If two positive findings were recorded, the larger of the two lesions was designated as the index lesion unless they share the exact characteristics. In that case, it was reported as “both proximal and distal.” Proximal colon lesion was defined as lesion noted in the splenic flexure and all the segments proximal to the splenic flexure. Distal colon lesions were defined as lesions distal to splenic flexure. 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. Non-advanced adenoma was defined as an adenoma that is smaller than 10 mm and had no high-risk features.

RESULTS:
Out of the 459 patients, 24 patients had “adenocarcinoma,” 334 patients were noted to have an “advanced adenoma” and 101 patients who had “non-advanced adenoma.” Out of the 24 cancer patients, 70.83% had distal cancer, while 25% had proximal cancer. Interestingly, one patient had a proximal and distal cancer at the same time. The distribution of advanced adenomas was different and the location was shared equally between proximal and distal in 47.31% and 49.40% respectively, while the remaining 3.29% had advanced adenoma in the proximal and distal colon simultaneously. Among patients with non-advanced adenoma, 62.38% of the adenomas were proximal, 26.73% were distal while 10.89% of the patients had evidence of non-advanced adenoma in both proximal and distal colon.

CONCLUSION:
The location of the “positive findings” on colonoscopy following a positive DNA test varied significantly based on the final diagnosis. Among patients with positive fecal DNA test, more significant pathology such as an advanced adenoma or adenocarcinoma was noted to be in the distal colon.
251 Detection Rates by Anatomic Location in Caucasians, Hispanics, and Asians
Authors: Moosvi Zain , Abadir Alexander , Roccato Mary Kate , Karnes William 
Published: October 2019

INTRODUCTION:
Ethnic and racial disparities in colorectal cancer (CRC) incidence and mortality rate have been well studied in the literature. However, no study to date has compared surrogates of precancerous polyp prevalence: adenoma detection rate (ADR), polyp detection rate (PDR), sessile serrated adenoma detection rate (SDR) amongst ethnic groups with respect to polyp location. This study serves to compare ethnicities with respect to ADR, PDR, and SDR in 3 ethnic groups as a function of anatomic location.

METHODS:
This retrospective nonrandomized nonblinded cohort study utilized prospectively collected data at our single tertiary referral center from the UCICQDRes database. A total of 19 attendings and 55 fellows performed 8,894 colonoscopies from June 2012 to October 2018. Three study subgroups (Asian n = 1505, Hispanic n = 951, and Caucasian n = 6438) were compared for age, gender, BMI, total procedure time (TT), bowel prep score (BPS), cecal intubation rate (CIR), ADR, PDR, and SDR stratified by anatomic location.

RESULTS:
Asians had the highest BPS and age, while Hispanics had the lowest TT. There were differences in PDR and ADR across the ethnicities in all areas of the colon. For instance, in the cecum, Caucasians had the highest PDR (0.18, P = 0.0007), ADR (0.11, P = 0.0142), and SDR (0.027, P = 0.0034). In the left colon, SDR was not significantly different between the ethnicities. With the exception of transverse colon ADR, Hispanics had the lowest PDR and ADR for all anatomic locations.

CONCLUSION:
Except for ADR in transverse colon and SDR in the descending colon, Hispanics had significantly lower ADR, PDR, and SDR compared to other ethnicities. That Hispanic patients, in general, had lower detection rates in all anatomic locations may be at least partially attributed to the lower BPS and higher BMI and TT in this group. Further analysis is required to ascertain the effect of these variables. In the cecum and ascending colon, differences in ADR, PDR and SDR were significant between all groups. This study suggests that variations in detection rates based on anatomic location may contribute to variations in CRC incidence rates across ethnicities. Additional studies may be of interest to confirm and further explore these differences, as they may have the potential to warrant ethnicity-dependent CRC screening guidelines.
253 Geographic Early-Onset Colorectal Cancer Incidence Rate Disparities Within White and African American Populations in the United States
Authors: Abualkhair Wesal , Zhou Meijiao , Wu Xiao-Cheng , Karlitz Jordan J. 
Published: October 2019

INTRODUCTION:
Prior study by our group revealed marked geographic disparities in early-onset colorectal cancer (EOCRC) incidence rates (IR) (Abualkhair et al. abstract #984 DDW 2019). Although it is established CRC IRs in African Americans are higher than whites, there is paucity of data on geographic EOCRC disparities within both white and African American populations. Hence, we seek to explore the role race may play in IR differences between U.S. regions and individual registries.

METHODS:
2000–2015 SEER 18 CRC IR Analysis (170,434 cases) was performed in one-year age increments (ages 30–60) in four U.S. regions, individual registries and stratified by race.

RESULTS:
There are wide regional IR disparities at multiple ages within both white and African American populations. For example, at age 45, there is a 52% difference (P < 0.05) between the highest (south) and lowest (west) regional IRs in African Americans compared to a 32% difference (P < 0.05) in whites (Figures 1 and 2). At multiple age points <50, there is a trend for greater disparity between the highest and lowest regional IRs within the African American population compared to within the white population (shaded boxes in Figure 2) however these did not reach statistical significance at most ages.

CONCLUSION:
There are marked geographic EOCRC IR disparities within white and African American populations between U.S. regions. There appears to be a trend toward more pronounced geographic disparities within the African American population, however interpretation is limited by lack of statistical significance at multiple age points, likely due to lower case counts. Targeting all populations is critical for CRC prevention, however we must assure attention is paid to higher-risk populations. Potential interventions include targeted risk factor modifications, assuring concerning symptoms trigger prompt diagnostic evaluations and taking advantage of earlier age 45 screening options supported by some guidelines (USMSTF recommends screening African Americans at age 45 and ACS recommends average-risk screening of all patients at age 45). By identifying higher-risk populations, future targeted studies can also be performed which may allow better understanding of rising EOCRC rates.
257 White Women Are More Frequently Assessed for Hereditary Colon Cancer Risks Compared to Minority Women
Authors: Pascual Lauren , Kirelik Danielle , Cioffi Joseph , Borum Marie 
Published: October 2019

INTRODUCTION:
It is estimated that 5% of individuals with colon cancer inherited a mutation which increased their risk for the malignancy. Multi-generational family histories are recommended to preliminarily determine genetic risks and initiate referrals for genetic counselling. While women may frequently be assessed for genetic risks associated with breast cancer, it is unclear if GI providers consistently obtain family history in women seeking colon cancer screening. This study evaluated the rates of family histories obtained in women referred for colon cancer screening at a university medical center.

METHODS:
A retrospective chart review evaluated all women seen by GI providers for colorectal cancer (CRC) screening in the gastroenterology clinic of a university medical center during a 3 month period. Patient age, race, documentation of family history (3 or more generations) was obtained. A confidential database was generated using Microsoft Excel. Statistical analysis using Fisher's Exact Test was performed with significance set at P < 0.05. The study was approved by the institutional IRB.

RESULTS:
500 medical records were reviewed. The mean age was 59.6 (range 33–89). Self-reported race/ethnicity included 276 African-American, 123 White, 32 Hispanic, 30 Asian, 20 other and 19 undocumented. 102 (20.4%) had a multi-generational family history. White women were significantly more likely to have a documented 3 generation history compared to all other women (30.08% vs 16.48%), P = 0.0016. African-American compared to white women were less likely to have detailed family histories obtained (17.03% vs 30.08%), P = 0.0050.

CONCLUSION:
This study demonstrated that multi-generational family histories were not adequately obtained in women by GI providers during colon cancer screening visits. White women compared to all other women more often had detailed family histories documented. Despite African-American women having the highest prevalence of colon cancer among all women in the United States, multi-generational family histories were less frequently obtained. While this study is limited by single institutional design, reliance upon provider documentation and short duration, it provides a foundation for additional research. Increased provider and patient education about the potential significance of family history in colon cancer risk assessment is critical to optimize outcomes.
262  The Effect of Deep Sedation on Adenoma Detection Rate in Screening Colonoscopies: A Meta-Analysis and Systematic Review
Authors: Alomari Mohammad , Al Momani Laith , Bratton Hunter , Aasen Tyler , Thota Prashanthi N. , Sanaka Madhusudhan R. 
Published: October 2019

INTRODUCTION:
The cornerstone of colon cancer prevention is high-quality examination of the entire colonic mucosa at designated intervals. Deeper sedation has been correlated to greater patient satisfaction, shorter procedures, and faster recoveries. However, disagreement exists on whether deeper sedation correlates to an increase in adenoma detection rate (ADR); a surrogate marker of colonic visualization. The aim of this meta-analysis is to evaluate the previously published research on the difference in ADR in colon cancer screening colonoscopies between deep and moderate sedation (i.e., conscious sedation).

METHODS:
We performed a comprehensive literature search in PubMed, PubMed Central, Embase, and ScienceDirect databases from inception through May 2019, to identify all human studies that evaluated the association between deep sedation with Propofol versus moderate sedation and the rate of adenoma detection. We included studies that presented an odds ratio (OR) with a 95% confidence interval (CI) or included data sufficient to calculate the OR with a 95% CI. Statistical analysis was performed using the Comprehensive Meta-Analysis (CMA), Version 3 software.

RESULTS:
Five studies with a total of 112,098 patients undergoing screening colonoscopies were included in this study, 6,476 of which received deep sedation with Propofol (5.8%). The pooled OR for ADR in patients who underwent deep sedation with Propofol compared to moderate sedation is 1.137 (95% confidence interval: 1.019–1.269, P = 0.022; I2 = 37.756%) (Figure 1). No publication bias was found using Egger's regression test (Figure 2).

CONCLUSION:
Our results indicate that patients receiving deep sedation with Propofol are 14 percent more likely to have adenoma detected during a screening colonoscopy than in those who are moderately sedated. To our knowledge, this study represents the first meta-analysis to assess this association. Future prospective randomized research is needed to confirm this association before making any changes in the standard practices of sedation during screening colonoscopies.