bluuebunny/crossref_metadata_2025_split huggingface dataset:
244 Exogenous Insulin Therapy Increases the Risk of Advanced Colorectal Adenoma Among Patients With Type 2 Diabetes Mellitus
Authors: Lam Robert , Chennareddy Sumanth , Brahmbhatt Mihir , Glassman Caroline , Yang Yu-Xiao 
Published: October 2019

INTRODUCTION:
Endogenous hyperinsulinemia increases the risk of colorectal cancer (CRC) among patients with type 2 diabetes mellitus (T2DM). Exogenous insulin therapy, used by 30% of T2DM patients, further increases systemic levels of insulin and has been shown to increase the risk of CRC in animal models. We sought to evaluate the effect of exogenous insulin therapy on the incidence of advanced adenoma in T2DM patients.

METHODS:
We conducted a retrospective cohort study among patients with T2DM aged 40–80 at a tertiary healthcare center. Among other inclusion/exclusion criteria (Figure 1), eligible patients must have undergone 2 rounds of colonoscopy examinations – a baseline colonoscopy and a follow-up (index) colonoscopy ≥1 year later. Primary outcome was incident advanced adenomas at index colonoscopy. Primary exposure was long-term (≥1 year) insulin therapy before index colonoscopy. Assuming α = 0.05, background advanced adenoma incidence of 5%, and prevalence of insulin therapy among T2DM of 20%, a cohort size of 865 would be required to have 90% power to detect a 7.5 percentage point increase in advanced adenoma incidence among long-term insulin users. Multivariable logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI).

RESULTS:
Among patients with ≥1 diagnostic code for DM and ≥2 colonoscopy procedure codes, we randomly selected 1,900 patients for chart review and identified 867 eligible patients (Figure 1). Except for BMI, baseline characteristics between short-term/non-insulin users versus long-term insulin users were not significantly different (Table 1). Characteristics of the baseline and index colonoscopies were similar between the two groups (Table 1). Incidence of advanced adenoma at index colonoscopy was higher among the long-term insulin users versus short-term/non-insulin users (20% versus 4.7%, chi2
P < 0.001). Multivariable adjusted OR for advanced adenoma risk associated with long-term insulin use was 6.2 (95% CI: 3.4–11.3). Long-term insulin use was also associated with increased risk of having ≥3 adenomas (adjusted OR 2.8, 95% CI 1.4–5.4) and having ≥1 right-sided advanced adenoma (adjusted OR 6.9, 95% CI 3.5–13.8) at index colonoscopy.

CONCLUSION:
Chronic insulin therapy was associated with increased risk of advanced adenoma occurrence in T2DM patients. This novel observation is important for developing a risk-tailored approach to the use of colonoscopy in CRC screening/surveillance in patients with T2DM.
245 Dietary Calcium and Vitamin D Intake and Colonic Mucosa-Associated Microbiome in Healthy Individuals
Authors: Chen Ellie , Ajami Nadim , Chen Liang , White Donna , Cole Rhonda , Hair Clark , Graham David Y. , El-Serag Hashem B. , Petrosino Joseph , Jiao Li 
Published: October 2019

INTRODUCTION:
Studies have demonstrated antitumor or anti-inflammatory properties of calcium and vitamin D. Dietary calcium and vitamin D intake has been associated with lower risk of colorectal cancer. However, the effect of calcium and vitamin D intake on gut microbiota is not well understood.

METHODS:
This is a cross-sectional study of 99 colonic biopsies of 35 individuals (average age 62 years, 77% Caucasian and 1 woman) with poly-free colonoscopy between August 2013 and April 2017 at Michael E. DeBakey VA Medical Center. Microbial DNA was isolated and the V4 region of the16S rRNA gene was amplified then sequenced for microbiome profiling. A food frequency questionnaire was used to ascertain calorie-adjusted calcium and vitamin D intake. Median intake was used to dichotomize the intake to low vs. high. Sequencing data were analyzed using the UPARSE and SILVA database for operational taxonomic unit (OTU) classification. Alpha-diversity (Shannon index), beta-diversity (weighted UniFrac) and relative abundance of bacteria (Mann-Whitney test) were compared between low vs. high intake. Reported P-value was adjusted for multiple comparisons using false discovery rate (FDR).

RESULTS:
Compared with lower intake, higher dietary calcium and vitamin D intakes were both associated with greater richness and evenness (P value < 0.005). The community composition also differed by calcium and vitamin D intake (P = 0.001). In phylum level, the relative abundance of Verrucomicrobia was greater in individuals with higher calcium and vitamin D intake (P values < 0.005). In genus level, high consumption of both calcium and vitamin D were associated with a significantly higher relative abundance of Akkermansia, Faecalibacterium, Dialister, Haemophilus, Odoribacter, Fusicatenibacter, and Paraprevotella, but a lower abundance of Erysipelatoclostridium and Lachnoclostridium (FDR P values < 0.05). Higher intake of calcium, but not vitamin D, was also associated with lower abundance of Bacteroides and higher abundance of Parabacteroides (P values = 0.02).

CONCLUSION:
Higher intake of calcium and vitamin D was associated with a higher diversity of colonic microbiota and higher abundance of potentially beneficial bacteria and lower abundance of harmful bacteria in healthy individuals. Further metagenomics and metabolomics research are needed to understand whether and how the protective effect of calcium and vitamin D on colorectal cancer is partially mediated through gut microbiome.
263 Male Gastroenterologists Have Better High-Risk Adenoma Detection Rate (HRADR) in Male Patients
Authors: Alomari Mohammad , Al Momani Laith , Bratton Hunter , El Kurdi Bara , Khazaaleh Shrouq , Wadhwa Vaibhav , Thota Prashanthi N. , Sanaka Madhusudhan R. 
Published: October 2019

INTRODUCTION:
High-risk adenomas (HRA) have been associated with a significant risk of interval colorectal cancer development. Recent literature suggests that high-risk adenoma detection rate (HRADR) can be used as a complementary screening colonoscopy quality metric. Being dependent upon the experience- and skill-level of the provider, we aimed in this study to investigate the impact of gastroenterologists' gender on HRADR among screened patients.

METHODS:
A retrospective review of all screening colonoscopies in patients ≥50 years of age performed at our center between 2012 and 2014 was done. Average risk patients who had a complete colonoscopy with excellent, good, and fair bowel preparation were included. Overall, gender-specific, and segment-specific adenoma detection rates (ADR), large adenoma detection rate and high-risk adenoma detection rates (HRADR) were calculated and compared using t-tests. HRADR defined as either ≥3 adenomas or at least one adenoma of ≥10 mm (big adenoma) or at least one tubule-villous adenoma, high grade dysplasia or cancerous polyp.

RESULTS:
A total of 2641 patients were included in the analysis. Average patient age was 58 ± 7.6 years and 53.2% were females (Table 1). Compared to female gastroenterologists, male gastroenterologists had better overall HRADR (9.8 ± 6.6 vs. 5.0 ± 4.0; P < 0.012) and overall Distal HRADR (4.6 ± 5.0 vs. 1.2 ± 2.2, 0.019). In male patients, male gastroenterologists had better proximal and distal HRADR (6.4 ± 7.0 vs. 1.8 ± 2.7; P < 0.021 and 6.3 ± 7.4 vs. 1.2 ± 3; P < 0.016, respectively). In female patients there was a non-significant trend toward better overall and segment-specific HRADR (P-value = 0.97, 0.56 and 0.30). Also, male gastroenterologists were better at detecting large adenomas (>1 cm) in male patients (7.4 ± 8.3 vs.1.7 ± 3.3; P < 0.016). All endoscopists met the nationally recommended ADR thresholds (25% overall, 20% for females and 30% for males).

CONCLUSION:
In this study, male gastroenterologists had better overall HRADR and overall Distal HRADR among all screened patients. In male patients, male gastroenterologists had better proximal and distal HRADR and were better at detecting large adenomas. This association was consistent across patient age, race, and level of colon preparation. These findings suggest that the differences in screening colonoscopy training and/or volume between male and female gastroenterologists may have important clinical implications in the detection of colon cancer and patient outcomes.
265 Beyond Polyp Detection: Novel Method to Track Individual Polyps Using Neural Networks
Authors: Requa James , Dao Tyler , Ninh Andrew , Karnes William 
Published: October 2019

INTRODUCTION:
Polyp detection using neural networks (NNs) during colonoscopy shows promise for reducing adenoma miss rate. NNs are also being developed to document polyp features, including their pathology, size and shape, as well as procedure quality measures, including cecal intubation, withdrawal time and prep quality. Counting polyps of predicted size, shape and pathology is also critical for determining appropriate surveillance intervals at point-of-care. The latter requires NNs capable of “remembering” each polyp to avoid recounting at each re-encounter.

METHODS:
The polyp-tracking system includes 3 components: 1) Polyp Detection/Localization: YOLO-based Convolutional Neural Network architecture which identifies & localizes new polyps in the colon in real-time during colonoscopy procedure; 2) Polyp Future Positioning: Recurrent Neural Network Bi-directional LSTM (Long Short-Term Memory) that predicts polyp's future position based on temporal features across sequential video frames and 3) Polyp Re-Identification/Matching: one-shot learning Siamese Neural Network that outputs a “similarity score” expressing the likelihood that two polyps are the same.

RESULTS:
YOLO-based polyp detection algorithm was trained on 7000 polyp images (unique polyps), 7000 non-polyp images and can achieve a detection rate of over 99% on validation set of 3000 images. Both LSTM polyp future positioning algorithm & Siamese Net polyp re-identification algorithms were trained on sequences of detected polyps in video frames from 400 colonoscopy video clips and validated on 100 clips. For the LSTM, with objective to predict center-point coordinates for polyp in the next (future) frame, it achieved <0.001 validation loss (mean-squared-error) compared to ground truth center-point coordinates and can process inference at 1000 FPS. For polyp re-identification, we achieved 94.7% validation accuracy at re-identifying the same polyp across frames.

CONCLUSION:
Polyp tracking will provide many benefits to AI-assisted colonoscopy, including correct polyp counting, more accurate rendering of predictions of optical pathology, polyp size and polyp shape. Theoretically, the technology could be modified to assist in finding a lost polyp, in alerting the colonoscopist to unseen surfaces, and defining finding locations.
271 Higher Charlson-Deyo Score May Result in Delay to Colonoscopy in Veterans Subsequently Diagnosed With Colorectal Cancer
Authors: Khuc Thi , Jackson Christian 
Published: October 2019

INTRODUCTION:
Colorectal cancer (CRC) is the second most common cause of cancer deaths in the United States and expected to cause 51,020 deaths in 2019. Early detection with yearly fecal occult blood test (FOBT) has been proven to decrease CRC mortality. A 30-day delay from positive FOBT to colonoscopy has been shown to be associated with increased risk of CRC.
1
Currently, the Veterans Affairs Health System (VAHS) treats approximately 11% of CRCs in the United States. The compounding effects of an aging population, physician shortage, and increased military personnel entering the VAHS can increase demands on VAHS resources. The primary aim of this study was to determine risk factors that caused delay to colonoscopy.

METHODS:
We retrospectively reviewed records of 600 patients referred for colonoscopy between January 1999 and January 2009 and were subsequently diagnosed with CRC. Patients were excluded if a prior CRC diagnosis had been established. The final study cohort consisted of 530 patients. Using Chi square and Fisher's testing, we examined the relationship between 10 variables and delay in time from initial consultation to colonoscopy. Variables consisted of age, sex, race, ethnicity, CRC location, marital status, history of mental health diagnosis, tobacco use, substance abuse, Charlson/Deyo (C/D) score and season of referral for colonoscopy. A delay in time was defined as 30 days or greater. Further logistic regression analysis adjusted for age, race, CRC location and C/D score.

RESULTS:
A total of 87.17% of patients experienced a delay in time from initial consultation to colonoscopy. When analyzed with a predictive variable of delay to colonoscopy, C/D score of ≥2 versus 0, was associated with higher odds of delay in time to colonoscopy (OR = 2.18, P = 0.02). African American race and Hispanic ethnicity was associated with a higher odds of delay in time to colonoscopy, but was not statistically significant (OR = 1.47, P = 0.47, OR = 1.37, P = 0.48).

CONCLUSION:
Patients with a C/D score ≥2 were 218% more likely to have delay in time from initial consult to colonoscopy, resulting in a delayed CRC diagnosis. C/D score may be used to determine which patients should have more frequent reminders to schedule their colonoscopy to prevent delays in care. Randomized and prospective studies will need to be performed.
276 Low Rates of Colonoscopic Surveillance Among Patients With High Risk Adenomas
Authors: May Folasade , Corona Edgar , Yang Liu , Nguyen B. Sean , Lin Christina , Huang Marcela Zhou , Shao Paul , Mwengela Didi , Didero Michelle , Asokan Ishan , Bui Alex , Hsu William , Maehara Cleo , Naini Bita , Kang Yuna , Bastani Roshan 
Published: October 2019

INTRODUCTION:
There have been a myriad of efforts to address suboptimal colorectal cancer (CRC) screening rates in the United States (US). Individuals with high-risk colon polyps detected during screening colonoscopy have 2- to 5-fold increased risk for the future development of CRC; however, there are few efforts directed towards optimizing risk reduction in this group. We examined surveillance uptake for patients with high-risk polyps in a large, academic healthcare system.

METHODS:
\We identified a cohort of patients: 1) age 50–75; 2) with a colonoscopic diagnosis of high-risk adenoma (HRA; 1 adenoma >1 cm, adenoma with villous histology, adenoma with high-grade dysplasia, or 3 or more adenomas) between January 2013 and January 2016; and 3) regular primary care (PC) at UCLA Health. We collected information from the electronic health record (EHR) on demographics, polyp histology, colonoscopy completion, and office visits. We determined the proportion of patients that completed surveillance colonoscopy each year and used Student's t-tests and chi-square tests to evaluate univariate associations between patient characteristics and colonoscopy completion.

RESULTS:
Our cohort included 203 individuals with HRA. Mean age was 62.5 (SD = 7.6), 62.6% were male, and 75.3% were White (Table 1). There were 153 (75.4%) patients who did not complete surveillance within 3 years. Surveillance completion increased from 24.6% to 40.4% by 3.5 years. 110 (54.2%) completed surveillance by the end of 5 years (Table 2). In all, 202 (99.5%) patients had documentation of a PC visit and 165 (81.3%) had documentation of a GI visit before surveillance was due. There were 121 (59.6%) patients with a documented history of adenoma in the EHR problem list. Patients with ≥1 GI visit after HRA diagnosis (165, 81.3%) were more likely to complete surveillance than patients without a GI visit after HRA diagnosis (38, 18.7%) (P < 0.001).

CONCLUSION:
Overall uptake of surveillance colonoscopy was low at 3 years for patients with HRA. There was notable improvement in follow-up by 3.5 years; however, adherence remained suboptimal at 40%. Clinical implications of this delay are unknown. Documentation of adenoma history was low. Individuals with HRA represent a group that has been largely neglected in CRC prevention/control research and that warrants evidence-based strategies to ensure appropriate follow-up to reduce CRC burden.
281 Elimination of Language Barriers as a Strategy to Decrease Colorectal Cancer Screening Disparities in Underserved Hispanics: Is This Enough?
Authors: Ajayi-Fox Patricia , Flocco Gianina , Romero-Marrero Carlos 
Published: October 2019

INTRODUCTION:
Despite the overall increase in colorectal cancer screening (CRCS) rates, disparities are still observed in minority groups, such as Hispanics. Suggested reasons for this are poor health literacy, different cultural attitudes about health and language barriers. To determine the impact of eliminating language barriers among Hispanics in CRCS, we analyzed differences in CRCS rates between Hispanics served at a bilingual underserved clinic to African Americans and Hispanics served at other non-bilingual clinics.

METHODS:
A retrospective review of CRCS rates of selected minority patients seen at our institution between 1/1/13 and 12/31/18 was conducted. Three outpatient primary care clinics were included: a clinic located at our Main Campus (GC), one with predominantly African American patients (AC), and a Hispanic clinic (HC) at an alternate location. While GC and AC had only English-speaking providers, the Hispanic clinic (HC) had exclusively bilingual providers. For GC, only Hispanic patients were included. Variables analyzed included general demographics, CRCS rates, screening method, quality of bowel preparation and adenoma detection rates.

RESULTS:
A total of 3963 patients were included in the study. Sixty percent were female. Average age of screening was 58, 57 and 58 at HC, GC and AC respectively (p 0.093). Overall, the predominant method of CRCS was colonoscopy (45.1%), however AC had a high rate (13.6%) of FIT utilization. 65.7% of patients had good or excellent bowel preparation quality, and there was a 37.2% adenoma detection rate (ADR). When comparing clinics, there was a statistically significant difference in CRCS rates (43.4% HC, 58.7% GC and 59.5% AC, P < 0.001), good bowel preparation quality (53.6% HC, 68.5% GC and 69.2% AC, P < 0.001) and adenoma detection rates (29.8% HC, 29.3% GC and 40.3% AC, P < 0.001).

CONCLUSION:
Our study shows that, despite the elimination of language barriers, disparities affecting underserved Hispanic patients remain in colorectal cancer screening rates, bowel preparation quality and adenoma detection rates. Language alone may not be all that is needed for improving CRCS in underserved Hispanic populations and a multifactorial approach is needed for this. The higher CRCS at AC could be attributable to their high number of FIT tests. One potential intervention would be increasing FIT at the HC as an initial screening method.
286 Colonoscopy Outcome Similarities and Differences Between GI Providers and Non-GI Providers in Patients Who Undergo 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 published aggregated results of colonoscopy outcome in patients who had a positive stool DNA test. In this study, we compare the outcome of colonoscopy based on the specialty of the provider who performed the procedure.

METHODS:
Review of charts of 1413 patients who had a positive stool DNA followed by documented colonoscopy was done. At total of 4 patients were excluded. Two patients were excluded because of finding of “other carcinoma” aside from adenocarcinoma while the other 2 were excluded because the provider type was unknown. Attention was given to the specialty of the provider performing the procedure. Patients were divided in 2 groups. Group 1 included patients who had their colonoscopy done by a GI provider while group 2 included patients who had their colonoscopy done but a Non-GI provider. 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 1409 patients included in the study, colonoscopy was performed by a gastroenterologist in 1180 (83.75%) of the patients, by a general surgeon in 198 (14.05%) of the patients, and by a primary care provider (internal medicine or family medicine) in 31 (2.2%) of the patients. The findings in group 1 and group 2 were compared. “adenocarcinoma” was found in 2.03% vs. 0% respectively (P = 0.02). “Advanced adenoma” was found in 23.98% vs. 22.27% respectively (P = 0.58). “10 mm adenoma” was found in 7.71% vs. 4.37% respectively (P = 0.07). Non advanced adenoma was found in 30% vs. 26.64% respectively (P = 0.31). Finally, no adenomas were found in 36.27% vs. 46.72% respectively (P = 0.003).

CONCLUSION:
This study shows similarities and differences in outcomes of colonoscopies in patients who have positive stool DNA test between high volume and low volume providers. GI providers and non GI providers had a difference in their findings of non advanced adenoma and adenocarcinoma. Further prospective studies are needed to validate these results.
295 Colonoscopy Use Among Dominicans: An Analysis of the New York City Community Health Survey (2003–2016)
Authors: Glenn Matthew , Xia Yuhe , Ng Sandy , Lin Kevin , Nagpal Neha , Liang Peter S. 
Published: October 2019

INTRODUCTION:
Screening for colorectal cancer (CRC) reduces incidence and mortality. Latinos are more likely to be diagnosed with late-stage CRC than non-Latino whites, a disparity that may be partially attributed to lower rates of screening among Latinos. New York City (NYC) has the fourth largest Latino population in the U.S., with Dominicans comprising the largest subgroup (41%). The current study examines predictors of up-to-date colonoscopy use among Dominicans using the NYC Community Health Survey (NYCCHS).

METHODS:
The NYCCHS is an annual population-based telephone survey of New Yorkers aged 18 and older. We included all Dominicans aged 50 and older who participated in the survey from 2003–2016. The outcome of interest was up-to-date colonoscopy use, defined as having completed a colonoscopy within the past 10 years. To evaluate sociodemographic and medical predictors of colonoscopy uptake, we entered age, sex, and all factors with P < 0.10 on univariate analysis into multivariable models for each of four consecutive time periods: 2003–2008, T1; 2009–2012, T2; 2013–2014, T3; and 2015–2016, T4. The final models were determined using stepwise backward selection.

RESULTS:
Results for 3,237 Dominican participants are shown in Table 1. On multivariable analysis, two variables were significantly associated with colonoscopy use in three of the time periods: age ≥65 (T1, T2, T4) and having received a flu vaccine in the prior year (T1, T3, T4). Two variables were significantly associated with colonoscopy uptake in two time periods: foreign birth (T1, T4) and longer duration of residence in the US (T2, T3). Variables associated with up-to-date colonoscopy use in only one time period included having a primary care provider (T2), being unemployed (T2), self-rated poor health status (T2), residence in Queens (T3), and not drinking sugar-sweetened beverages (T3).

CONCLUSION:
Among Dominicans living in NYC, older age, foreign birthplace, longer duration of residence in the US, and receiving the flu vaccine were the most consistent factors associated with up-to-date colonoscopy use.