bluuebunny/crossref_metadata_2025_split huggingface dataset:
261 Sessile Serrated Polyp Detection Rate as a Screening Colonoscopy Quality Metric
Authors: Alomari Mohammad , Al Momani Laith , El Kurdi Bara , Khazaaleh Shrouq , Sarmini Muhammad Talal , Wadhwa Vaibhav , Thota Prashanthi N. , Sanaka Madhusudhan R. 
Published: October 2019

INTRODUCTION:
Adenoma detection rate (ADR) is an established colonoscopy quality metric primarily used to prevent interval colorectal cancer (CRC). Likewise, higher sessile serrated polyp detection rates (SSPDR) were linked to reduced interval CRC. Recently, some studies suggested the use SSPDR as a quality indicator with proposed benchmarks mimicking that seen in ADR where 25% of all procedures should yield adenomas (20% for females and 30% for males). We aimed in our study to examine the utility of SSPDR as a quality metric for screening colonoscopies with proposed new target benchmarks.

METHODS:
A retrospective review of all screening colonoscopies in patients ≥50 years of age performed at our tertiary center between 2012 and 2014 was done. Average risk patients who had a complete colonoscopy with excellent, good, or adequate bowel preparation were included. Overall and segment specific ADR and SSPDR were calculated and compared using t-tests. Data is presented as mean ± standard deviation or frequency (%). The adjusted R-Squared statistic (R2) was used to test the correlation variability. The P-value corresponds to the correlation between ADR and SSPDR. All analyses were done using SAS (version 9. 4, The SAS Institute, Cary, NC) and a P-value < 0. 05 was considered statistically significant.

RESULTS:
A total of 4151 patients were included in the analysis. Average patient age was 60.0 ± 7.7 years and 53.2% were females. Colonoscopies were performed by 54 (64.3%) gastroenterologists and 30 (35.7%) non-gastroenterologists (General Surgeons = 9; Colorectal Surgeons = 21) (Table 1). Overall ADR was 26.4 ± 11.0, overall SSPDR was 19.3 ± 11.4. Overall SSPDR that corresponds to a predicted ADR of 25% was 16% (adjusted R2 = 0.16, P-value < 0.001). SSPDR in females that corresponds to an ADR of 20% was 10% (adjusted R2 = 0.11, P-value = 0.001) (Figure 1). These findings reflect a significant but poor correlation between ADR and SSPDR.

CONCLUSION:
Based on a large screening colonoscopy registry-based analysis, our results support the use of SSPDR as an ancillary rather than independent colonoscopy quality metric. The current study suggests a cut-off values of 16% for overall SSPDR and 10% for the female papulation. SSPDR above these values may be congruous with adequate serrated polyp detection rates. Further multicenter studies are needed to validate our findings.
266 “Google It:” Relationship Between Google Searches on Colon Cancer Screening Tests and State-level Screening Rates
Authors: Sutherland Bryn L. , Pribnow Kaylee , Browne Jason , Weiss Jennifer M. 
Published: October 2019

INTRODUCTION:
One third of eligible adults in the United States are not up to date with colorectal cancer (CRC) screening. Improved access to information through search engines such as Google could impact health behavior. Google Trends is a publicly available tool that quantifies Google search volumes for a given timeframe, location and set of terms yielding a value up to 100 called relative search volume (RSV). The goal of this study was to examine the relationship between state-level RSVs for CRC screening modalities and screening rates.

METHODS:
Google Trends searches by CRC screening modality were conducted for 1/1/2013–12/31/2016 with the following terms: (1) “colonoscopy,” (2) “flexible sigmoidoscopy + sigmoidoscopy + flex sig,” (3) “virtual colonoscopy + CT colonography,” (4) “fecal occult blood test + FOBT + blood stool test for cancer + fecal immunochemical test + FIT,” and (5) “cologuard + stool DNA test.” State-level CRC screening rates were obtained from the 2016 Behavioral Risk Factor Surveillance System data. Correlation between state-level CRC screening rates and RSV for each modality were evaluated with Pearson correlation coefficients. States were divided into quintiles based on screening rates and multinomial logistic regression was performed on RSVs for each modality across quintiles.

RESULTS:
There was a moderately strong positive correlation between state-level CRC screening rates and RSVs for colonoscopy (r = 0.49, P < 0.001) and a weak positive correlation for Cologuard® (r = 0.37, P = 0.009). Multinomial regression showed no difference in RSVs for all modalities across the top three quintiles. However, when compared to the top quintile, states in the bottom quintile searched for colonoscopy 20% less (RRR = 0.81, P = 0.016) and the second lowest quintile were significantly less likely to search for CT colonography (RRR = 0.66, P < 0.001) and Cologuard® (RRR = 0.94, P = 0.03).

CONCLUSION:
State-level CRC screening rates correlate with Google Trends state-level RSVs for colonoscopy and Cologuard®. This may mean that states with higher screening rates are engaging adults by utilizing both invasive and non-invasive screening modalities. States in the top three quintiles for CRC screening showed relatively similar search patterns while the bottom two quintiles had significantly lower RSVs for alternatives to colonoscopy. CRC screening awareness campaigns in states with lower screening rates should include promotion and education of all available options for CRC screening.
268 Early-Onset Colorectal Cancer Annual Percent Change Incidence Analysis in 20–29 and 30–39 Year-Olds Utilizing 2000–2016 SEER 18 Data and Stratified by Histology
Authors: Montminy Eric M. , Zhou Meijiao , Maniscalco Lauren , Wu Xiao-Cheng , Abualkhair Wesal , Karlitz Jordan J. 
Published: October 2019

INTRODUCTION:
SEER 9 analysis has revealed rising early-onset colorectal cancer (EOCRC) incidence. We seek to analyze SEER 18 EOCRC rates as this represents a greater percentage of the U.S. population compared to SEER 9 (28% vs. 9%). Furthermore, given evidence carcinoid (CN) rates are increasing and these tumors may potentially be broadly categorized as “colorectal cancer,” we aimed to substratify analysis by histology.

METHODS:
Age-specific CRC, colon only and rectal only incidence rates from SEER 18 (2000–2016) were generated in yearly intervals using SEER*Stat. Age 20–29 and 30–39 blocks were analyzed and Joinpoint regression was used to calculate annual percent changes (APC). Histologic categories included all CRCs, adenocarcinomas (AC), CNs and CRCs without CNs.

RESULTS:
Age 20–29 overall CRC APC was 3.39% from 2001–2013 and 14.55% from 2013–2016. Colon AC APCs (1.03% from 2000–2016) and rectal AC APCs (7.42% 2000–2006, −0.24% 2007–2016) in 20–29 year-olds were not statistically significant. However, colorectal combined ACs had a statistically significant, modest APC of 1.12%. In contrast, 2007–2016 age 20–29 colon CN APC was 41.05%. Rectal CN APCs were not significantly changed. Age 30–39 overall CRC APCs were 1.58% from 2000–2010 and 4.03% from 2010–2016. Age 30–39 2000–2016 colorectal AC APCs were 1.89% with a colon AC APC of 1.59% and rectal AC APC of 2.40%. Age 30–39 colonic CN APCs were 32.81% from 2010–2016. Rectal CN APCs were 2.90% from 2000–2016.

CONCLUSION:
Age 20–29 overall CRC rate increases in SEER 18 appear to be driven in large part by increasing CN incidence. Although there was a significant colorectal AC APC of 1.12% in 20–29 year-olds, there was no significant APC increase in colon ACs. There appeared to be an increased APC trend in rectal ACs from 2000–2006 (7.42%), however this was non-significant and there was a negative trend from 2006–2016. In contrast, colon and rectal ACs in the 30–39 age group have been steadily increasing. In both age groups, colon CNs have been increasing faster than rectal CNs. Reasons are unclear but could potentially represent increased use of colonoscopy which can detect proximal lesions. Study limitations include underreported age 20–29 CN rates from 2000–2006. Overall, findings support rises in CRC incidence in young adults, however this is less from ACs in 20–29 year-olds. Despite these findings, ACs are still present in 20–29 year-olds and concerning symptoms should trigger diagnostic evaluations.
269 Colorectal Cancer Annual Percent Change Incidence Analysis in 40–49 and 50–54 Year-Olds Utilizing 2000–2016 SEER 18 Data and Stratified by Histology
Authors: Montminy Eric M. , Zhou Meijiao , Maniscalco Lauren , Wu Xiao-Cheng , Abualkhair Wesal , Karlitz Jordan J. 
Published: October 2019

INTRODUCTION:
SEER 9 analysis has revealed rising incidence of early-onset colorectal cancer (EOCRC) in 40–49 year-olds and within 50–54 year-olds. We seek to analyze SEER 18 EOCRC rates as this represents a greater percentage of the U.S. population compared to SEER 9 (28% vs. 9%). Furthermore, given evidence carcinoid (CN) rates are increasing and these tumors may potentially be broadly categorized as “colorectal cancer,” we aimed to sub-stratify analysis by histology.

METHODS:
Age-specific CRC, colon only and rectal only incidence rates from SEER 18 (2000–2016) were generated in yearly intervals using SEER*Stat. Age 40–49 and 50–54 blocks were analyzed, and Joinpoint regression was used to calculate annual percent changes (APC). Histologic categories included all CRCs, adenocarcinomas (AC), CNs, and CRCs without CNs.

RESULTS:
Age 40–49 overall CRC APC was 1.45% from 2000–2016. Colon AC APC was 1.08% from 2000–2016, and rectal AC APC was 1.49% 2000–2016. Age 50–54 overall CRC APCs was 1.06% from 2000–2016. Age 50–54 2000–2016 CRC AC APCs was 0.55% with a colon AC APC of 0.27% and rectal AC APC of 1.09%. Age 40–49 CRC CN APC was 4.58% from 2000–2016. Age 50–54 CRC CN APCs were 10.35% from 2000–2008, −1.09% from 2008–2012, and 9.41% from 2012–2016. All results were statistically significant except Age 50–54 colon AC APC 2000–2016 (0.27%) and Age 50–54 CRC CN APC 2008–2012 (−1.09%).

CONCLUSION:
Age 40–49 and 50–54 overall CRC rate increases in SEER 18 appear to be driven by all histology sub-types, including AC and CN. Although there was significant increase in colorectal AC APC of 0.55% in 50–54 year-olds, there was no significant APC increase in colon ACs, but significant increase in rectal ACs. In both age groups, colon and rectal CNs incidences have been increasing faster than ACs. Importantly, rising CN incidence is significantly factoring into the increase in CRC in ages 40–49 and 50–54. Reasons are unclear but could potentially represent increased use of colonoscopy which can detect proximal lesions. Overall, findings support rises in CRC incidence in EOCRC and ages 50–54. Despite these findings, ACs are still rising in 40–54 year-olds, and concerning symptoms should trigger diagnostic evaluations.
270 Telehealth-Based Colonoscopy Education May Be a Viable Alternative to In-Person Colonoscopy Education Among Veterans
Authors: Khuc Thi , Jackson Christian , Chao Daniel 
Published: October 2019

INTRODUCTION:
The VA Loma Linda Healthcare System (LLVA) offers an in-person colonoscopy education class (IPCC) and a telehealth based education class to patients who live closer to outlying VA designated Community Based Outpatient Clinics (CBOCs). Anecdotally, we noticed a significant number of cancellations and no-shows for colonoscopy from patients who sought care from CBOCS. We developed a telehealth based colonoscopy class (TBCC) to be given at CBOCs. The primary aim of the study was to determine effectiveness of TBCC compared to the existing IPCC by evaluating class attendance rates, colonoscopy attendance and quality measures of colonoscopy.

METHODS:
We retrospectively reviewed records of 1429 LLVA and CBOC patients referred for colonoscopy class between April 2014 and April 2015. Patients were given the choice of attending IPCC or TBCC. The primary end points were polyp detection rate (PDR), adenomas detection rate (ADR) and adenocarcinoma detection rate (ACDR). Secondary endpoints were attendance to TBCC and IPCC and attendance to colonoscopy. Attendance was defined as the percentage of patients who complied with their first scheduled appointment. We examined the relationship between age, BMI, sex, race, and indication for colonoscopy in the IPCC and TBCC populations.

RESULTS:
TBCC attendance rate was higher than IPCC (P = 0.001). There was no significant difference in attendance to colonoscopy between TBCC and IPCC (P = 0.50). Patients receiving primary care at CBOCs more likely chose TBCC versus patients receiving primary care at LLVA who chose IPCC (92.53% vs. 24.77%, P < 0.0001). African Americans and Hispanics more likely chose IPCC, while whites more likely chose TBCC (P = 0.01). Patients with family history of colorectal cancer and bright red blood per rectum as indications for colonoscopy more likely chose IPCC (P = 0.004, P = 0.008). Sixty eight percent of colonoscopy preparations were noted to be good. There was no difference in the number of good preparations between TBCC and IPCC (94.3% and 96%, P = 0.025). ADR was higher in patients who received IPCC (44.55% and 52.17%, P = 0.02). There was no significant difference in PDR and ACDR between TBCC and IPCC groups.

CONCLUSION:
A TBCC program is a means of increasing patient attendance to colonoscopy preparation training without negatively affecting quality of colonoscopy preparation. Prospective, randomized studies on differences in adenoma detection and distance from home residence on class and colonoscopy attendance rates is needed.
273 Multi-Target DNA Aberrations in Sporadic Colorectal Cancer Tissues Do Not Differ Between Younger and Older Patients
Authors: Limburg Paul , Mahoney Douglas W. , Ahlquist David , Allawi Hatim T. , Johnson Scott , Kaiser Michael W. , Statz Sandra , Graham Rondell , Foote Patrick , Doering Karen , Burger Kelli N. , Lidgard Graham , Kisiel John 
Published: October 2019

INTRODUCTION:
Colorectal cancer (CRC) screening is broadly endorsed for individuals 50–75 years of age. Given recent increases in CRC incidence and mortality for patients <50 years old, the American Cancer Society now recommends initiation of average-risk CRC screening at age 45 (Wolf AMD CA Cancer J Clin 2018). The performance of recommended tests, including the multi-target stool DNA (mt-sDNA; marketed as Cologuard™) test, has been minimally described in populations under 50 years old. To address this knowledge gap, we conducted a retrospective study of DNA markers (KRAS, BMP3, NDRG4) included in the mt-sDNA assay to quantify and compare tissue marker levels in sporadic CRC cases and normal colon controls from patients in 45–49 and 50–64 year-old age groups. Our primary hypothesis was that mt-sDNA marker levels would be statistically similar between cases in both age groups.

METHODS:
Patient samples were identified from a pathology tissue archive at Mayo Clinic, excluding those with inflammatory bowel disease or familial cancer syndromes. Formalin-fixed, paraffin-embedded tissues were reviewed by a GI pathologist for 45–49 year-old (n = 90) and 50–64 year-old (n = 96) CRC cases; normal colon samples (45–49, n = 76; 50–64, n = 92) were also included for comparison. DNA extracted from core punches was blinded and processed in a randomized order. Quantitative Allele specific Realtime Target and Signal amplification (QuARTS) assays were used to quantify KRAS mutations, and BMP3 and NDRG4 methylation. Marker level in each sample was reported as the QuARTS product of mutant KRAS, methylated BMP3 or NDRG4 relative to the ACTB product in each sample, reported as a percentage. At least 60 patients per group provided sufficient power to demonstrate differences in marker levels of ±25% between case groups and between control groups using the Wilcoxon Rank Sum test.

RESULTS:
CRC cases in the 45–49 vs 50–64 year-old groups did not differ significantly with respect to sex (P = 0.77) or race/ethnicity (P = 0.06); left-sided CRC was more common in the 45–49 vs 50–64 year-old group (87% vs. 72%; P = 0.02). None of the marker levels were statistically different between cases of the younger vs older groups or between controls of these groups (Figure 1).

CONCLUSION:
These data support the expectation of no age-related differences in CRC detection by mt-sDNA, as the relevant molecular markers, when they occur, are present at similar levels across age groups 45–49 and 50–64 years.
274 Can We Predict Low Quality Colonoscopy? Establishing Open Access Colonoscopy at a Fellow-Run Gastroenterology Clinic
Authors: Sullivan Matthew J. , Aleem Abdul , Essrani Rajesh , Hickey Patrick , Nellis Eric , Andrews Robert , Shah Hiral N. , Shah Shashin 
Published: October 2019

INTRODUCTION:
Open access colonoscopy (OAC) is the process by which a patient is referred directly for colonoscopy without a pre-procedure consultative office visit. This process has been shown to decrease wait time for screening colonoscopies which can subsequently improve adherence rates. However, identifying patients at increased risk for complications or low quality colonoscopy who would benefit from a pre-procedure office visit can be difficult and no specific society guidelines exist.

METHODS:
At our fellow-run gastroenterology clinic, we retrospectively evaluated all patients who underwent screening colonoscopy during the 2016 to 2018 academic years with the aim of identifying any difference in colonoscopy quality parameters between patients deemed eligible or ineligible for OAC. The charts of all patients at average risk for colorectal cancer who were scheduled for screening colonoscopy with a fellow during the study period were reviewed. For this study, all patients were seen at an office visit prior to their procedure. We also individually evaluated our exclusion criteria for OAC.

RESULTS:
45 of 68 (66.2%) patients would have been eligible for OAC based on our current exclusion criteria. We examined 3 quality indicators for screening colonoscopy and full results are available in Table 1. Overall, there were no significant differences between the groups for bowel prep adequacy, cecal intubation rate, or adenoma detection rate (ADR). However, prep adequacy approached significance (P = 0.076). Patients taking an anticoagulant, those with NYHA class III or IV CHF, CKD4-5, or uncontrolled diabetes (A1c 8% or greater) were significantly more likely to have an inadequate bowel prep. Uncontrolled diabetes was our most frequent reason for ineligibility for OAC.

CONCLUSION:
Literature on OAC is robust, but pathways involving trainees and studies examining exclusion criteria are less prevalent. Our study demonstrated no significant differences in quality indicators for colonoscopy in patients ineligible for OAC, but did reveal significant differences in prep adequacy for certain medical conditions. Interestingly, the ADR for ineligible patients (27.3%) was higher than that for eligible patients (22.2%). Our results indicate that further investigation is required to identify patients who would benefit from a pre-colonoscopy office visit. Our exclusion criteria also require further examination to identify other potential risk factors or sub-groups at risk for low quality colonoscopy.
277  Evaluating Cancer Outcomes of Outpatient Colonoscopies in Elderly Patients Older Than 85 Years of Age
Authors: Lee Joy A. , Bi Xia , Huang Connie Y. , Coyle Walter 
Published: October 2019

INTRODUCTION:
With increasing life expectancy and a growing body of aging patients, the incidence of gastrointestinal diseases including colorectal cancer increases. Currently, there are few studies on cancer outcomes of outpatient colonoscopy in patients older than 85 years of age.

METHODS:
The endoscopic database at Scripps was queried for all outpatient colonoscopies performed under moderate sedation between April 1, 2012 to March 31, 2017 on patients aged 85 years and older. Endoscopy reports were reviewed for demographics, indication for procedure, and endoscopic findings. Variables including location and stage of tumor, subsequent treatments, and overall mortality were analyzed.

RESULTS:
322 outpatient colonoscopies were reviewed. Median age was 86 years. 53% were females. Screening colonoscopies accounted for 2.1% of procedures. 40 (12.4%) colon cancers were detected. 38 (95%) were adenocarcinomas and 2 (5%) were neuroendocrine tumors. Of these, 26 (65%) were right sided colon cancers. Among patients diagnosed with cancer, anemia was the most common indication followed by positive fecal occult blood test (FOBT). 20 (50%) of these patients had a FOBT within the past year. Of those FOBTs, 18 (90%) were positive. Median age of patients with colon cancer was 88 years, with 70% females. 12 (30%) patients had never had a prior colonoscopy. Of those with colon cancer, 19 (47.5%) were diagnosed at an advanced-stage (stage III or IV). Among patients who received treatment, 32 (80%) pursued surgery, 10 (25%) received chemotherapy, and 5 (12.5%) received radiation. 3 (7.5%) patients received supportive care only. 1-year mortality was 22.5% and 3-year mortality was 40% from the time of diagnosis.

CONCLUSION:
To date, this is the first study in the United States that examines cancer outcomes in an elderly population over age 85 undergoing an outpatient colonoscopy. Overall, colonoscopies in this age group resulted in a high cancer detection rate with anemia being the most common indication for a colonoscopy. Almost half of the detected cancers were advanced-stage and prognosis was overall poor. Interestingly, FOBT may be a useful screening tool to help clinicians assess whether a colonoscopy should be pursued in the elderly population. These findings will hopefully provide clinicians guidance on screening tools and treatment options that can be offered to the growing elderly population.