bluuebunny/crossref_metadata_2025_split huggingface dataset:
267 Family Comes First: GI Providers May Inconsistently Perform Multi-Generational Family History When Assessing Colon Cancer Risk
Authors: Cioffi Joseph , Kirelik Danielle , Pascual Lauren , Borum Marie 
Published: October 2019

INTRODUCTION:
Approximately 5–10% of cancers are attributable to hereditary cancer syndromes. It is recommended that a preliminary risk assessment for colon cancer include a family history in first and second degree relatives, genetic testing when appropriate and tumor analysis when possible. GI providers can optimize clinical decisions regarding colon cancer screening by obtaining multi-generational family history. However it is uncertain if providers consistently document family history for possible referral for genetic testing. This study evaluated rates of multi-generational family history documentation by GI providers in patients referred for colon cancer screening at a university medical center.

METHODS:
A retrospective chart review of all patients referred for colon cancer screening to the gastroenterology clinic during a 3 month period was performed. Patient gender, age, race, indication for CRC screening, documentation of a family history (3+ 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:
872 medical records (500 females, 372 males) with a mean age of 59.2 (range 29–89) were reviewed. Self-reported race/ethnicity included 452 Black/African-American, 363 White, 54 Hispanic, 42 Asian, 36 other and 34 undocumented. 144 (16.51%) had a multi-generational family history. Detailed family history was obtained significantly more often in females (102; 20.4%) compared to males (41; 11.02%) (P = 0.0023) and in whites (58; 22.05%) compared to non-whites (77; 13.39%) (P = 0.0023). Female providers were significantly more likely to obtained a detailed family history compared to male providers (26.9% vs 9.81%) (P = 0.0001).

CONCLUSION:
This study revealed that there was inconsistent documentation of multi-generational family history by GI providers in patients referred for colon cancer screening. Females and whites were more likely to have family risk assessment. Female providers more frequently obtained detailed family histories. While this study is limited due to duration and single institution design, it provides important information for subsequent studies and educational intervention. It is important that there is optimal assessment of colon cancer risk in effort to improve early detection and outcomes.
272  Artificial Intelligence Based Computer Aided Detection System Reliably Detects Polyps Earlier Than Physicians During Colonoscopy
Authors: Quan Susan Y. , Friedland Shai , Pirsiavash Hamed , Kompella Ravindra , Sachdev Vineet 
Published: October 2019

INTRODUCTION:
Artificial intelligence (AI) is increasingly being used as an aid to physicians in multiple areas of medicine. Computer aided detection (CAD) has the potential to assist endoscopists in detection of colon polyps and flat lesions during colonoscopy. Real-time detection of polyps can potentially increase adenoma detection rates and decrease adenoma miss rates, as computerized algorithms are able to analyze the entire field of view more rapidly than humanly possible and do not suffer from fatigue or distraction.

METHODS:
We designed a deep learning based CAD system that is able to process 30 endoscopy video frames per second in real time and highlight one or more polyps that are detected anywhere in the field of view. Our deep learning algorithm was trained on 26000 images extracted from hundreds of procedure recordings. The detection performance of the CAD system was measured on 100 colonoscopies. To compare how early the CAD system detects relative to endoscopists, 25 different colonoscopy video clips of varying length (30–180 sec) that included a single polyp were reviewed by 5 experienced endoscopists. The endoscopist pressed a button on the computer keyboard as soon as the polyp was visualized, and the time was recorded. This was compared to the time at which the CAD system detected the polyp.

RESULTS:
In the 100 clinical colonoscopy cases, a total of 250 polyps were found and removed in 86 patients (14 patients had no polyps detected). There were 171 tubular adenomas, 54 hyperplastic polyps/mucosal excrescences, 11 inflammatory polyps, 6 villous adenomas, 6 sessile serrated polyps and 2 traditional serrated adenomas. The CAD system detected 247/250 polyps (98.8%). The 3 polyps that were not detected were: one 6 mm serrated polyp, one 4 mm tubular adenoma and one 3 mm tubular adenoma. Separately, as shown in Figure 1, the early detection experimental analysis revealed that more than 49% of the polyps were detected earlier by the CAD system by 2 seconds or more. CAD system typically detected much earlier when physicians initially missed brief transient visibility (<500 ms) of the polyps.

CONCLUSION:
Our deep learning based CAD system is capable of detecting 99% of polyps that are found during routine colonoscopy. The system detects polyps significantly faster than physicians. Future studies will address whether this translates into higher adenoma detection rates or reduced miss rates in clinical practice.
275 Annual Ultrasound Screening Value in Patients With Familial Adenomatous Polyposis
Authors: Yu Justin , Balasubramanian Adithya , Agarwal Suneal , Gallagher Kathleen 
Published: October 2019

INTRODUCTION:
Patients with familial adenomatous polyposis (FAP) are at an increased risk for developing papillary thyroid cancer (PTC). The American College of Gastroenterology clinical guidelines have recommended annual thyroid ultrasound screening (TUS) for FAP patients. The goal of this study is to investigate the cost effectiveness of annual TUS screening in this patient population using a novel financial and epidemiologic model.

METHODS:
A cost analysis was performed to determine the financial viability of annual TUS compared to biennial (every 2 years) or triennial (every 3 years) screens. Population growth was modeled using a variable growth rate based on previous trends in the United States growth rate. Key modeling parameters including TUS sensitivity/specificity, prevalence of FAP, and risk of PTC in FAP patients were extracted from the literature. Treatment protocols based on early versus late detection were adopted from the American Thyroid Association and the National Comprehensive Cancer Network guidelines. Costs for each component were ascribed using either the Centers for Medicare & Medicaid Physician Fee Schedule or literature values. The cumulative cost savings was derived as a function of these parameters and time.

RESULTS:
The prevalence of FAP was estimated at 3 in 100,000 with a 6.8% risk of PTC. The cost for early detection was $10,582 compared to $37,277 for late detection. TUS sensitivity/specificity were found to be 0.83 and 0.90. Using these parameters, our model revealed that annual TUS screening is only financially viable for a short interval. A maximum cumulative cost savings of over $10.3 million is observed after 2 years of implementation. After this time, the cumulative cost savings decreases at a rate of $780,000 per year and becomes negative after 15 years. Biennial and triennial screening intervals extend the period of financial viability to 30 and 45 years, respectively. Triennial screening results in a maximum cost savings of $10.4 million after 4 years.

CONCLUSION:
FAP patients are at an increased risk of developing PTC. TUS screening is warranted for early detection and treatment, but annual TUS screening may not be financially viable in the long term. Guidelines for annual screening may need to be re-examined and extended to every 2 or 3 years.
280 Patients With Non-Colorectal Cancers May Be at Elevated Risk of Colorectal Neoplasia
Authors: Abu-Sbeih Hamzah , Ali Faisal , Lum Phillip , Qiao Wei , Shafi Mehnaz A. , Bresalier Robert , Hawk Ernest , Raju Gottumukkala , Wang Yinghong 
Published: October 2019

INTRODUCTION:
Screening for colonic neoplasia has decreased the incidence of colorectal cancer in the United States in the past two decades. Whether personal history of noncolorectal cancer is a risk factor for colonic neoplasia has not been studied. We assessed the risk of colorectal neoplasia in noncolorectal cancer survivors.

METHODS:
We conducted a retrospective study of patients who had undergone colonoscopy for any indication between 2009 and 2018. Colonic adenoma detection rate and multivariate logistic regression were conducted to assess for the primary outcomes of the study.

RESULTS:
The study included 9408 cancer patients and 3295 control patients. Colonic adenomas were detected in 4503 cancer patients (48%) and 950 cancer-free patients (29%). Histologic examination of these adenomas revealed tubulovillous features in 620 patients (5%) and villous in 153 (1%). High-grade dysplasia was detected in 1611 patients (13%). Invasive colorectal adenocarcinoma was detected in 455 patients (12%); this rate was highest in patients with multiple myeloma (14%) (Table 1). Multivariate analysis revealed that a personal history of noncolorectal cancer was associated with increased risk of adenoma (Odd ratio, 2.04; 95% CI, 1.84–2.26; P < 0.001). The adenoma detection rate was 30% in patients younger than 40 years (n = 1211), 32% in patients between 41 and 50 years (n = 812), 47% in patients between 51 and 60 years (n = 2892), and 55% in patients older than 60 years (n = 4493) (Figure 1).

CONCLUSION:
The adenoma detection rate in patients with a personal history of noncolorectal cancer is higher than the reported rate of the general population and our control group.
283 Too Few or Too Many Endoclips to Close Polypectomy Defect After Endoscopic Mucosal Resection?
Authors: Mouchli Mohamad , Walsh Christopher , Reddy Shravani , Mir Adil , Kesar Varun , Shakhatreh Mohammad , Chitnavis Vikas , Yeaton Paul 
Published: October 2019

INTRODUCTION:
Endoclips could be placed prophylactically at the polypectomy site after the removal of large polyps to prevent post-polypectomy bleeding. The effect of an increased number of endoclips deployed after endoscopic mucosal resection (EMR) on polyp recurrence is unknown.

AIMS:
Evaluate the risk of polyp recurrence in patients with large polyps undergoing EMR based on the number of endocips deployed.

METHODS:
We identified all patients with documented large colon polyps 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, additional treatments required, number of endoclips used, and number and timing of surveillance endoscopies were extracted. The cumulative risks of polyp recurrence after first resection using EMR technique were estimated using Kaplan-Meier curves.

RESULTS:
One-hundred and thirty patients (Mean age, 64.2 ± 10.7 yrs; 43.1% males) with polyps removed using EMR (60 (46.2%) removed in piecemeal fashion, 70 (53.8%) removed en bloc) were identified. The mean size of polyps resected was 2.12 ± 1.12. Argon plasma coagulation and/or the tip of the snare were used to cauterize remnant polyps in 42/130 (32%). Eighty-six patients (66.2%) required endoclips deployment to close the polypectomy defect (Table 1). At follow-up endoscopy, 14/53 (26.4%) in group 1 and 14/33 (42.4%) in group 2 developed polyp recurrence at the polypectomy site within a median of 5.9 months. The median time for recurrence after polypectomy was longer for pts in group 1 as compared to those in group 2 (P < 0.01) (Figure 1). After excluding patients receiving cauterization of the remaining polypoid tissue after EMR, median time for recurrence after polypectomy remained longer for pts in group 1 (P = 0.03) (Figure 2). Late post-polypectomy bleeding occurred despite endoclips deployment in 2/53 (3.8%) in group 1 and 4/33 (12.1%) in group 2.

CONCLUSION:
Large polyps EMR appear to be associated with higher recurrence rate in lesions requiring more than three endoclips. These findings need to be confirmed in prospective trials.
285 Adherence to Recommending 10-Year Intervals After Normal Screening Colonoscopy in Average-Risk Individuals: A Snapshot of 2017 for Phase 1 of the Michigan CRC Screening Quality Improvement Project
Authors: Schoenfeld Philip , Kathi Pradeep R. , George Khalid , Goyal Sachin , Kim Hyungjin M. , Tommolino Emily , Piper Marc 
Published: October 2019

INTRODUCTION:
The Michigan CRC Screening Quality Improvement Project (CRC-QIP) is a multi-center, 4-phase project to improve adherence with recommending 10-year intervals after normal screening colonoscopies. Per guidelines, target is 90% adherence with recommended intervals.

METHODS:
Inclusion criteria: In order to minimize possible confounders, patients were limited to: (a) average-risk, 50–75 year olds; (b) colonoscopy performed in 2017; (c) sole indication-CRC screening; (d) no biopsy, polypectomy, or any abnormal findings on procedure report. Study Setting: In order to minimize confounders when stratifying for specialty and type of practice, only medical centers with (a) GI fellowship program; (b) Hospital-based “open” endoscopy unit (i.e., utilized by private practice gastroenterologists (GIs), colorectal surgeons, and general surgeons). Primary Outcome: Adherence to guideline-consistent intervals defined as repeat colonoscopy in 10 years or discontinue CRC screening due to patient's age when bowel preparation is adequate or <1 year if bowel preparation is inadequate. Primary analysis is frequency of adherence based on endoscopist specialty after adjusting for multiple confounders, including procedure-related factors (e.g., withdrawal time), and endoscopist-related factors (e.g., yrs in practice, solo vs group practice, colonoscopies performed per yr). Hierarchical logistic regression model was used with adherence as the dependent variable with random intercepts for endoscopist performing procedure to account for correlation between endoscopist and site as fixed effects.

RESULTS:
Among 1,694 eligible patients, mean age was 58.7 ± 6.5, 43% male, and 68% African-American. Adherence was better for academic gastroenterologists with or without GI fellows vs private practice GIs or academic general surgeons (P = 0.04). The latter two groups were adherent in <40% of patients (Table 1). Adherence was significantly better with good/excellent bowel preps compared to all other bowel prep categories (P < 0.05), and patients with poor, fair, or no documentation of prep were adherent <50% (Table 2).

CONCLUSION:
In this project, adherence did not meet guideline-specified target of 90% among private practice GIs and general surgeons. Phase 2 will include additional analysis to identify factors associated with non-adherence and a mixed methods qualitative study to identify appropriate interventions to improve performance.
287 The Effect of Smoking on Multitarget Stool DNA Testing
Authors: Huq Nadia , Fahed Gracia , Inaganti Anupama , Affi Aboud , Fahed Julien 
Published: October 2019

INTRODUCTION:
There is a known association between smoking and the development of colorectal cancer. Newer screening tools for colorectal cancer including multitarget stool DNA testing may have differing results with regards to patients who smoke. To our knowledge, there have not been other studies looking at smokers who completed stool DNA testing. Our study was completed to evaluate the effect of smoking on stool DNA testing and subsequent colonoscopy.

METHODS:
A total of 19400 patients had multitarget stool DNA tests. There was 8448 who did not have the test, and 9008 tests completed had negative results. There were 1413 patients with positive stool DNA followed by documented colonoscopy. Patients with unknown smoking status or finding of other carcinoma aside from adenocarcinoma were excluded. Colonoscopy findings were recorded and were divided into smokers (former or current) and nonsmokers. Only the index lesion was recorded. Advanced adenoma was defined as an adenoma larger than 10 mm or had high risk features such as villous transformation or high grade dysplasia. Nonadvanced adenoma was defined as an adenoma smaller than 10 mm and had no high risk features. Advanced neoplasia was defined as adenocarcinoma or advanced adenoma. Statistical analysis with Chi-square was done to compare the proportions. A P-value < 0.05 was considered statistically significant.

RESULTS:
Among smokers, 5474 (54%) completed the stool study versus 5474 (59%) among nonsmokers (P < 0.01). The stool DNA test was positive in 1204 (22%) of the smokers versus 738 (13%) (P < 0.01). From the positive results, colonoscopy was completed in 896 (74%) of smokers versus 564 (77%) (P = 0.311). Follow-up colonoscopy yielded 16 (1.85%) adenocarcinomas in the smoking group versus 8 (1.47%) nonsmokers (P = 0.59), 285 (33%) advanced adenomas versus 149 (27%) (P = 0.025), 248 (29%) nonadvanced adenoma versus 168 (31%) (P = 0.395), and 315 (36%) with no adenoma versus 220 (40%) (P = 0.141). A total of 301 (35%) of smokers with a positive test had an advanced neoplasia versus 157 (29%) in nonsmokers (P = 0.02).

CONCLUSION:
From our study, there is an increased chance of a positive multitarget stool DNA test in smokers as well as a higher chance of finding advanced neoplasia. Further prospective studies are needed to validate patient characteristics for those being offered multitarget stool DNA testing. Smokers may benefit from more immediate colonoscopy given an increased risk of advanced neoplasia in lieu of other screening tools such as stool DNA testing.
291  Characteristics Associated With Young Colorectal Cancer in the United States
Authors: Ali Sajjadh M.J. , Catalano Marc F. 
Published: October 2019

INTRODUCTION:
The incidence of young colorectal cancer (20–49 years) has been rising since the early 1990s and the American Cancer Society has recommended that we lower the age of screening colonoscopy to 45. There is much debate about whether the incidence is truly rising or whether it is impacted by earlier screening in predisposed individuals. We aimed to study the factors which predict presentation of colorectal cancer at a younger age as compared to older patients aged above 50 years.

METHODS:
The SEER 18 database was queried for colorectal cancer cases from 1990 to 2016. Cases were classified into young (20–49 years) and old (≥50 years), and multinomial logistic regression was used to predict the race/ethnicity, gender and tumor characteristics that were more likely with younger patients as compared to older patients.

RESULTS:
818,621 total cases were reported. Analyses demonstrated that females were more likely than males to have colorectal cancer at a younger age (OR 1.055, CI 1.039–1.071). Non-Hispanic blacks were more likely than non-Hispanic whites to have younger age cancer (1.637, 1.383–1.937). Spanish Hispanic Latinos were more likely to have young cancer than non-Spanish Hispanic Latinos (2.128, 2.08–2.177). Indians/Pakistanis were more likely (1.277, 1.085–1.503) whereas Chinese (0.546, 0.495–0.602) and Japanese (0.372, 0.334–0.414) were less likely to have young cancer when compared to whites. Stage IV and III (1.586, 1.523–1.651; 1.575, 1.515–1.637) were more likely with young cancer than Stage I. Tumor sites such as rectum (1.351, 1.323–1.381) were more likely whereas ascending colon (0.511, 0.495–0.527) and hepatic flexure (0.627, 0.597–0.658) were less likely to have young cancer than the sigmoid colon.

CONCLUSION:
Race/ethnicity, gender, tumor stage/site as well as grade/histology were found to predict colorectal cancer at a younger age as compared to older patients. Younger patients had higher chances of advanced cancer (Stage IV/III) at presentation compared to older patients possibly due to prophylactic screening of patients above 50 years. Colorectal cancer is common at the sigmoid colon; but rectum and rectosigmoid junction were associated more with young cancer while other sites like cecum, ascending colon, hepatic flexure and transverse colon were less likely to be young than old cancer. Studies based on stratifying these and other risk factors may provide clues to the rising incidence of young colorectal cancer, and further recommendations maybe made for screening colonoscopy at younger ages.
292 Fast Track Screening Colonoscopy Program in Colorectal Cancer Prevention
Authors: Casper Ephraim S. , Chokhavatia Sita , Pazwash Haleh , Santana-Joseph Sobeida , Ringelstein Leslie , McKenna Kathleen , Rubinoff Mitchell 
Published: October 2019

INTRODUCTION:
Purpose/Specific Aims: The purpose of this study is to assess the progress of the Fast Track Screening Colonoscopy program at The Valley Hospital in Ridgewood, NJ since its launch in June 2018.

OBJECTIVES:
1. To assess if this program can be effective in a suburban hospital. 2. To assess if this program can streamline the process of getting a screening colonoscopy. 3. To assess if this program can be safely administered.

HYPOTHESES/RESEARCH QUESTION(S):
In 2015, The Valley Hospital (TVH) made a commitment to the American Cancer Society and National Colorectal Roundtable to serve as a partner in achieving its 80% Screened for Colorectal Cancer (CRC) by 2018 initiative. The 2015 Community Health Needs Assessment revealed that 40% of healthy residents in the TVH service area do not undergo CRC screening. The need for healthy patients to consult with a gastroenterologist or colorectal surgeon prior to colonoscopy was identified as one barrier. The Fast Track Screening Colonoscopy program was developed to eliminate consultation before the procedure. In this program, a Nurse Practitioner/Navigator screens patients for eligibility, schedules colonoscopy, and performs a physical assessment in the endoscopy unit immediately prior to colonoscopy.

METHODS:
This is a retrospective review of prospectively collected data from 524 patients who contacted TVH about participation in Fast Track Screening Colonoscopy, focusing on the 124 patients who actually completed the program.

RESULTS:
The program launched on June 18, 2018. As of April 29, 2019, 124 patients have undergone screening colonoscopies in the Fast Track Screening Colonoscopy program. No serious adverse events were reported.

CONCLUSION:
What have we learned/accomplished? 1. This program attracted a large number of individuals interested in screening colonoscopy. 2. This program has successfully performed 124 screening colonoscopies in our suburban hospital from June 2018 to April 2019. 3. Adenometous and hyperplastic polyps were identified in 46 patients. 4. This program has streamlined the process of getting a screening colonoscopy. 5. There were no serious adverse events. This program with a dedicated Nurse Practitioner/Navigator can be adopted to increase CRC screening. Patients with adenoma will follow-up for surveillance with the provider to whom they were assigned. Further efforts will be directed toward expanding this program.