bluuebunny/crossref_metadata_2025_split huggingface dataset:
316 Colonoscopic Withdrawal Patterns in a Tertiary Academic Medical Center
Authors: Kim David , Stavrakis Dimitris , Cui Haiyan , Roe Denise , Banerjee Bhaskar 
Published: October 2019

INTRODUCTION:
Withdrawal time is an important quality measure in colonoscopy as numerous studies have shown its effect on adenoma detection rate. Withdrawal during colonoscopy can be affected by many patient factors, but also individual endoscopist’s preferences and practices. We sought to characterize withdrawal patterns in our academic center for quality improvement purposes.

METHODS:
Inclusion criteria: 1,114 patients at a tertiary academic center who underwent screening and surveillance colonoscopies. Exclusion criteria: patients with missing procedure timestamps, incomplete or aborted procedures, history of gastrointestinal malignancy, prior colon resection, genetic syndromes, or inflammatory bowel disease. For cecal intubation time and withdrawal time, log-transformation was applied to normalize the data. Linear regression was used to assess the association of cecal intubation time with withdrawal time and adjusted for age, gender, and body mass index (BMI). The same analysis was performed by indication (screening and surveillance) and by endoscopist.

RESULTS:
After adjusting for age, gender, and BMI, increased cecal intubation time was associated with longer withdrawal time for all patients (n = 1144, P = 0.049). Subgroup analysis showed that this pattern held true for patients undergoing screening (n = 488, P = 0.033) but not surveillance (n = 656, P = 0.545). Further subgroup analysis excluding procedures that had polyps removed to control for time spent resecting polyps during withdrawal showed similar results (Table 1). When stratified by endoscopist, two of seven faculty members exhibited an association of longer cecal intubation time with increased withdrawal times. Increased withdrawal time was not associated with prior knowledge of positive family history of colon cancer (P = 0.729), nor personal history of cancer (P = 0.464).

CONCLUSION:
Longer cecal intubation times are associated with increased withdrawal times in our center particularly with screening colonoscopies, but variability appears to exist between faculty members. Bias against a patient’s family history of colon cancer or personal history of cancer does not appear to affect withdrawal time. Further studies including other academic centers should be done to validate these findings.
320 Social Determinants of Health on the Choice of Colorectal Cancer Screening Among Louisiana Adults
Authors: Swaminathan Renugadevi , Morris James D. 
Published: October 2019

INTRODUCTION:
Colorectal cancer (CRC) is the second leading cause of cancer in the U.S. Louisiana has the third highest mortality rate of CRC. The CRC related morbidity and mortality rates are declining recently with screening by early detection and treatment. The common CRC screening options are FIT, FOBT, sigmoidoscopy, and colonoscopy. Of all the available options colonoscopy allows examination of the entire colon and it offers therapeutic benefit. Studies have shown that various demographic factors can affect the choice of CRC screening. The purpose of the study is to identify the impact of social determinants of health on the choice of CRC screening among Louisiana adults.

METHODS:
We performed a retrospective cohort study using the Behavioral Risk Factor Surveillance System(BRFSS) database from 2016, limiting our evaluation to Louisiana adults of age 50-75 years who had CRC screening (n = 1306). Demographics were categorized and examined among participants who had CRC screening with colonoscopy versus stool-based test. These factors include age (50-64 and 65-75), gender (male and female), ethnicity (Caucasian, African American, Hispanics and Others), education (attended/graduated College and attended/graduated High School), income (≥$50,000 and <$50,000) and health insurance coverage (Medicare and Private). Univariate logistic regression analysis evaluated the association of the demographic factors and the choice of CRC screening. Data analysis was performed using SAS® software.

RESULTS:
The odds of having colonoscopy when compared to a stool-based test was 1.94 times higher (95% CI 1.46 – 2.58) among participants of age 50-64 years compared to age 65-75 years. The participants who have a college education has 1.36 times higher odds (95% CI 1.03 – 1.80) of having colonoscopy compared to participants who did not go to college. The odds of choosing colonoscopy was 2.05 times higher (95% CI 1.55 – 2.71) among participants who have private health insurance compared to Medicare insurance, and 2.04 times higher (95% CI 1.53 – 2.72) among participants with an annual household income of $50,000 or greater compared to participants with income of less than $50,000. Gender and ethnicity have no association with the choice of CRC screening in our cohort.

CONCLUSION:
The social determinants of health that are associated with the greater odds of having colonoscopy compared to the stool-based test include age, income, education, and health insurance in our state-wide cohort.
322 Artificial Intelligence-Aided Colonoscopy: A Retrospective Analysis of Effect on Procedure Time
Authors: Roccato Mary Kathryn , Dao Tyler , Berry Rani , Karnes William , Rael Efren 
Published: October 2019

INTRODUCTION:
Artificial intelligence (AI) for colonoscopy promises to assist polyp discovery, in situ diagnosis and automated procedure documentation. Widespread adoption will require ease of use and value, defined as: improved quality at reduced cost. The aim of this study is to determine if use of AI lengthens procedure time.

METHODS:
Data was collected prospectively at a single academic medical center at point-of-care using UCICQD, inclusive of all GIQuIC data and locations, sizes and pathology of all polyps stripped of all PHI and IRB-exempt. AI-assisted colonoscopies (AC) and conventional colonoscopy (CC) were compared for differences in means of total procedure time (TT).

RESULTS:
A total of 8988 CCs and 166 ACs were analyzed without exclusions. Insertion time to cecum averaged 13.0 minutes in CC (95% CI 12.6-13.3 minutes) vs 11.4 minutes (95% CI 10.3-12.4 minutes) in AC, P = 0.007. Withdrawal time averaged 18.2 minutes in CC (95% CI 17.9-18.4 minutes) vs 18.1 minutes (95% CI 16.0-20.1 minutes) in AC, P = 0.03. Total procedure time averaged 31.1 minutes in CC (95% CI 30.7-31.6 minutes) vs 29.4 minutes (95% CI 27.2-31.7 minutes) in AC, P = 0.79.

CONCLUSION:
While excitement is high for AI assistance during colonoscopy, concerns about potential negative effects on efficiency in high volume ASC's remain. This retrospective comparison of AC and CC demonstrates that the use of AI is not associated with increased procedure time.
324 Anesthesia Assistance in Screening Colonoscopy and Adenoma Detection Rate Among Trainees
Authors: Krigel Anna , Patel Anish , Kaplan Jeremy , Kong Xiao-Fei , Garcia-Carasquillo Reuben , Lebwohl Benjamin , Krishnareddy Suneeta 
Published: October 2019

INTRODUCTION:
The use of anesthesia assistance (AA) with propofol sedation for screening colonoscopy has been increasing over the past decade, raising concerns about possibly increased complication rates without a proven improvement in colonoscopy quality indicators like adenoma detection rate (ADR). The effect of AA on ADR has not been extensively studied in trainees learning colonoscopy. We aimed to determine if type of sedation used during screening colonoscopy affects trainee ADR.

METHODS:
Using the endoscopy databases of two hospitals in our medical center, we identified all screening colonoscopies performed by 15 trainees from July 2014 through June 2018, including all screening examinations where the cecum was reached. We recorded patient demographics, trainee ADR, year of training, mean withdrawal time, bowel preparation quality, supervising attending ADR (excluding procedures with trainees), and type of sedation used for each procedure. Multivariable analysis was used to determine factors independently associated with trainee ADR.

RESULTS:
We identified 1,420 unique patients who underwent screening colonoscopy by a trainee during the defined time period meeting the inclusion criteria. Of these, 459 (32.3%) were performed with AA. Overall trainee ADR was 39.6%, with ADR increasing from 35.0% in year one of training to 42.8% in year three (P = 0.047). ADR for cases with AA was 37.9% while ADR for conscious sedation (CS) cases was 32.0% (P = 0.374). Despite this absolute difference of 5.9%, the use of AA was not associated with finding an adenoma on colonoscopy on multivariable analysis when controlling for all covariables (OR 0.86; 95% CI 0.67-1.10). Factors independently associated with trainee ADR included male gender (OR 1.66; 95% CI 1.33, 2.08), patient age (OR for patients ages 70-79 compared to ages 50-59: 1.84 [1.33, 2.52]), optimal bowel preparation quality (OR 1.58; 95% CI 1.07, 2.33), and supervising attending ADR (OR for attending ADR 30-39% and ≥40% compared to attending ADR < 20%: 4.22 [1.58, 11.027] and 3.67 [1.37, 9.87], respectively).

CONCLUSION:
Despite providing the ability to more comfortably sedate patients for screening colonoscopy, potentially providing the increased time required to improve trainee ADR, we found that the use of AA for screening colonoscopy did not affect trainee ADR. These results on trainee ADR and sedation type suggest that the overall lack of association between AA use and colonoscopy quality indicators is applicable to the trainee setting.
326 Implementation of Patient Navigators Reveals Barriers to and Increases Uptake of Colonoscopy After Positive Fecal Immunochemical Tests
Authors: Tran Vivy , Corona Edgar , Yang Liu , Boceck Jennifer , Lopez Antonio , Dermenchyan Anna , Roh Lily , Meshkat Sarah , Gomez Daniel , Han Maria , Croymans Daniel , Huang Marcela Zhou , May Folasade 
Published: October 2019

INTRODUCTION:
Patients with abnormal fecal immunochemical test (FIT) results require diagnostic colonoscopy to reduce mortality from colorectal cancer (CRC). Barriers to follow-up are multifactorial and include patient-, provider-, and system-level factors. Patient navigators (PN) can be effective in improving follow-up by helping patients overcome these barriers. We aimed to assess the impact of PN on clinical care processes required for colonoscopy completion after positive FIT in a large, academic health care system.

METHODS:
We included all UCLA Health outpatients with an abnormal FIT result between 12/1/2016 and 12/01/2018 without documentation of a colonoscopy. Two PN underwent training with a gastroenterologist and quality officer. For all FIT positive patients, PN 1) conducted a chart review to confirm lack of colonoscopy completion, 2) contacted the primary care provider when there was an inappropriate reason for lack of colonoscopy, and 3) called patients to review FIT results, encourage follow-up, address barriers, and schedule a colonoscopy. Intervention endpoints were 1) colonoscopy completion, 2) patient refusal, 3) provider felt colonoscopy inappropriate, and 4) patient left the health system. We determined the proportion of patients that reached each endpoint at 4 months and reasons providers reported that colonoscopy was not indicated after positive FIT.

RESULTS:
Our cohort included 131 subjects. Mean age was 62.8 (±7.3), 50.3% were female, and 49.6% were White. In all, 87 (66.4%) reached an intervention endpoint at 4 months (Figure 1). Twenty-seven (31.0%) received diagnostic follow-up: 12 (44.5%) had colonoscopy, 3 (11.1%) had CT colonography, 1 (3.7%) had sigmoidoscopy, and 11 (40.7%) reported colonoscopies outside the health system. Primary care providers that were contacted by the PN often did not feel colonoscopy was indicated (25, 19.1%), and many (10, 40.0%) cited recent colonoscopy (Table 1). There were 19 (21.8%) patients that refused follow-up colonoscopy.

CONCLUSION:
PN was effective in increasing diagnostic follow-up after positive FIT and revealed persistent challenges to appropriate resolution of positive FIT. Future efforts will improve provider education about appropriate use of FIT and evaluate if PN can improve timely diagnostic follow-up when tracking positive FIT patients prospectively.
335 Increased Frequency of Colonoscopy Complications in Patients With Positive Multitarget Stool DNA Testing for Colorectal Cancer Screening
Authors: Sadiq Omar , Alimirah Maryam , Naffouj Sandra , Askar Firas , Siddiqui Yousuf , Jinjuvadia Raxitkumar 
Published: October 2019

INTRODUCTION:
Large scale studies have demonstrated post-colonoscopy perforation rates to range between 0.005-0.085% with bleeding rates of roughly 0.3%. Standard of care currently requires patients undergo follow up colonoscopies after positive multitarget stool DNA testing to identify any culprit lesions. We hypothesize that endoscopists performing these procedures expose patients to higher risks of complications to locate culprit lesions due to positive multitarget stool DNA testing.

METHODS:
All patients with positive Multitarget Stool DNA Testing for Colorectal-Cancer Screening between January 1st, 2016 and October 30th, 2018 were reviewed. A total of 589 charts were selected for analysis of demographics, post-colonoscopy bleeding, perforation and emergency room visits within 14 days post procedure. Endoscopic findings were also collected. Advanced adenomas were defined as tubular or serrated adenomas with size greater than 1 cm or tubulovillous adenomas of any size.

RESULTS:
A total of 589 patients had positive multitarget stool DNA testing, of which, 427 had undergone subsequent colonoscopies. Sample characteristics showed mean age of 68.6, 60% female, mean BMI 30.2. 58% smoking history and 16% diabetics (mean A1c of 7.4). In addition to 7 diagnosed adenocarcinomas, 221 patients were noted to have an advanced adenoma. Immediate complications were noted primarily in patients with advanced adenomas, with 0.9% of patients demonstrating bleeding compared to 0.5% of patients without any culprit lesions. Overall frequency of bleeding complications was 0.7%. One patient had bowel perforation (0.2%). 10 patients (2.3%) went to the ER within 14 days of colonoscopy. 2.1% of patients with normal colonoscopies presented to the ER within 14 days of their colonoscopies.

CONCLUSION:
Currently, screening colonoscopy is the gold standard for diagnosing malignant and premalignant lesions. Noninvasive forms of screening exist to increase adherence to screening and minimize risk, however we have found that colonoscopies performed to assess positive test results also increase the risk of adverse events in these patients, even in patients with normal endoscopic findings. We found a rate of 2.3% ER visits within 14 days of colonoscopy compared to 0.76% in literature. Our rates of bleeding and perforation were also higher, however our low N limits extensive analysis of these findings.
336 Bowel Preparation for Patients With History of Inadequate Cleansing With 4L PEG-3350 (Golytely) Split-Prep: The 6 Liter PEG-3350 (Golytely®) Split-Prep
Authors: Tama Maher , Kathi Pradeep R. , Ravi Anand K. , Salim Madiha , Lilley Kirthi , Antaki Fadi , Schoenfeld Philip 
Published: October 2019

INTRODUCTION:
No prior prospective study has assessed the efficacy of a more intensive bowel preparation (prep) for outpatients who have already failed a 4 liter (4L) PEG-3350 (GoLYTELY®) split-prep. This study assesses efficacy and safety of a 4L-2L PEG-3350 split-prep.

METHODS:

Inclusion Criteria- (a) colonoscopy for average-risk screening, FIT+, family history-CRC, or colon polyp surveillance; (b) history of inadequate prep with 4L GoLYTELY® or >2 risk factors for inadequate prep (daily laxative, BMI > 35, diabetes, daily tricyclic antidepressant, daily opioid). Intervention: 4L-2L PEG-3350 (GoLYTELY®) split-prep consisting of clear liquid diet (all day) and drink 4L GoLYTELY® starting at 6pm on day before procedure PLUS drink 2L of GoLYTELY® starting 5 hours before colonoscopy. Patients completed a questionnaire about demographics, adherence to prep protocol, ease of drinking prep, and adverse events. Primary Outcome: Adequate bowel prep, defined by 2-2-2 or better on Boston Bowel Preparation Scale (BBPS), among patients who failed 4L GoLYTELY® split-prep. Secondary Outcome: (a) Adequate bowel prep among patients who failed 4l GoLYTELY® pm-only prep or any lower volume prep; and, (b) patients with > 2 risk factors for inadequate prep; Tertiary Outcome: Frequency of guideline-adherent recommendations for surveillance colonoscopy among patients with adequate prep and patients with inadequate prep (i.e., repeat colonoscopy in ≤ 1 year). Data Analysis: The intention-to-treat population included all patients who underwent colonoscopy and the per-protocol population only included patients who drank ≥ 75% of prep.

RESULTS:
204 consecutive patients met inclusion criteria and presented for colonoscopy. Demographic data: mean age = 65 (40-79 years); M: F = 189:15. Frequency of adequate prep in each group is presented in Table 1. Frequency of guideline-adherent recommendations was 89.6% in patients with adequate prep and was 96.6% among patients with inadequate prep. Three serious adverse events occurred: vomiting with ED visit, asymptomatic bradycardia (HR = 30-40) and spontaneous paroxysmal atrial fibrillation. Based on questionnaires, 28% stopped to pass stool during trip to endoscopy center and 80% would be willing to repeat the prep in the future.

CONCLUSION:
The 6L GoLYTELY® split-prep achieves adequate prep in > 85% of patients who have already failed a 4l GoLYTELY® split-prep.
337 High Rates of Young-Onset Colorectal Cancer Incidence and Mortality in an Urban Tertiary Referral Center: A Case for Earlier Screening Colonoscopy
Authors: Henry George , Smallfield George B. , Mangray Sasha 
Published: October 2019

INTRODUCTION:
The Multi Society Task Force for Prevention of Colorectal Cancer recommends initiating average risk screening for patients at age 45 in African Americans (AA) and at age 50 in all others. In the US, Colorectal Cancer (CRC) incidence and mortality has been increasing at a significant rate each year in patients younger than 50 years. This recent trend has not been insufficiently explored to inform modeling of CRC screening among asymptomatic average-risk patients who are younger than 50 years. Further study of the benefits and harms of screening in persons younger than 50 years is warranted.

METHODS:
We performed a retrospective analysis using TriNetX, a global federated health research network providing access to statistics on electronic medical records (diagnoses, procedures, medications, laboratory values, genomic information). Our analysis included all patients diagnosed with CRC from the period 2010 to 2019. We then excluded patients with a diagnosis of Inflammatory Bowel Disease and Hereditary Cancer Syndromes to identify only spontaneous CRC. We calculated the incidence per 100,000 persons of CRC in 5-year age groups between 20 and 59 years. We also performed Kaplan-Meier survival analysis in these groups.

RESULTS:
Between 2010 and 2019, there were 970 new cases of CRC in persons age 20 -59. The population consisted of 52% males, 48% females, race distribution: 54% Whites, 39% Blacks, 2% Asians, Other 5%. Mean age at diagnosis was 59. The incidence rates per 100 000 population were similar for the 40-45 age group and 45-49 age group (Figure 1). Patients aged less than 50 accounted for 33.7 percent of new CRC cases (Figure 2). Kaplan- Meier 5-year survival analysis showed lower rates of survival for patients aged 40-45 (47.1%) and 45-49 (43.9%), compared with patients aged 50-54 (54.8%) (Figure 3)

CONCLUSION:
Our study demonstrates high rates of CRC in patients less than 50 and this study may give further merit to the consideration of earlier screening in asymptomatic average risk patients. There is a definite need for large scale epidemiological studies to further evaluate this worrisome trend.
341 Association of Fellow Training Year and Sedative Use During Screening Colonoscopy
Authors: Shine Amal , Atassi Hadi , Liu Nanlong , Thomas Chandler , Furmanek Stephen , Liu David , McClain Craig 
Published: October 2019

INTRODUCTION:
Colonoscopy has become a key tool for colorectal cancer screening, but like any procedure, it is not without risk. The procedure can be done under conscious sedation. Risks of sedation include hypotension and hypoxia. Therefore, endoscopists aim to minimize the amount of sedation needed to reduce risk but keep the patient comfortable. At centers with gastroenterology fellowships, screening colonoscopies are performed by fellows in training. We sought to examine the relationship between the fellow’s level of training and the amount of sedation used during colonoscopy.

METHODS:
Data were collected on 640 patients undergoing screening colonoscopies at Louisville Veterans Affairs Medical Center, and 509 were excluded based on specific exclusion criteria, including known colonic disorders (e.g., IBD history, pre-existing malignancies) and lack of documented sedative use. Of 131 patients included, median age was 62, 86% patients were male, and 73% were white. Data were gathered by retrospective chart review of the fellow’s level of training (1st, 2nd, 3rdyear) at the time of colonoscopy and dosages of Midazolam, Fentanyl and Diphenhydramine used. Multiple Regression Model was used for analysis with corresponding P-values calculated. Statistical significance was set at P < 0.05. The total number of polyps detected was controlled for as this was thought to affect the duration of colonoscopy.

RESULTS:
Our study indicates that, although a fellow earlier into his/her training was hypothesized to be associated with increased sedative use, the association was not statistically significant for any of the three sedatives in this study. This is most likely due to the fact that there was little variability between the doses of each sedative and the small sample size.

CONCLUSION:
Data in literature is limited regarding the association between a fellow’s level of training and the amount of sedation used. Factors affecting sedation use include the experience of the endoscopist and possibly cecal intubation time. Larger studies are needed to further explore these findings, which may have future clinical implications regarding the introduction of specific guidelines for sedative use based on a fellow’s level of training.