bluuebunny/crossref_metadata_2025_split huggingface dataset:
236  Young Adults With Adenomas: How Does Their Risk for Metachronous Advanced Adenomas Compare With Older Adults?
Authors: Anderson Joseph C. , Butterly Lynn F. , Robinson Christina N. 
Published: October 2019

INTRODUCTION:
Recent increases in colorectal cancer (CRC) incidence in adults less than 50 years of age have led to more colonoscopies in this age group. As a result, there is an increasing number of adults <50 with adenomas detected. We used data from the New Hampshire Colonoscopy Registry (NHCR) to explore whether these younger adults with adenomas are at higher risk for future advanced findings than older patients, potentially requiring closer follow-up.

METHODS:
Our cohort was NHCR participants with at least one adenoma and/or serrated polyp on index exam and a follow-up colonoscopy at least 1 year after the index exam. Outcomes were the absolute and adjusted metachronous risks of advanced adenomas (AA: adenomas >1 cm, with villous elements or high-grade dysplasia, or CRC) and large (>1 cm) serrated polyps (SP). Incomplete exams and patients with IBD or genetic familial syndromes were excluded. We present absolute risk and adjusted risks from a logistic regression model stratified by age at index colonoscopy (<40, 40–49, 50–59, and 60+ (ref)). Covariates include findings on previous and index colonoscopy, sex, smoking, body mass index (BMI), time to follow-up (months), bowel preparation quality, and family history of CRC.

RESULTS:
Time to follow-up did not vary with age in our sample of 10,116 adults (Table 1). Absolute risk for metachronous AA was lower for younger patients (P < 0.0001) (Table 1), with the lowest risk in patients <40, similar risks in the 40–49 and 50–59 groups, and highest risk in patients >60. Adjusting for covariates did not change findings (P = 0.003). Because younger adults were less likely to have index AAs, we performed a sensitivity analysis, excluding index exams with AAs, and observed no changes in results (P = 0.003). The metachronous risk for large SPs was not significantly associated with age (Table 2).

CONCLUSION:
Younger adults with index adenomas have a lower risk for metachronous AAs than patients >50. These data suggest that younger adults are not at higher risk for metachronous advanced neoplasia than older adults. The data also suggest that surveillance intervals recommended by current guidelines for adults >50 years may be safe to apply to younger adults.
241 A Care Model for Optimization of Colorectal Cancer Screening in Western Pennsylvania
Authors: Umar Shifa , Cole Rita , Syed Aslam , Shankar Pallavi , Neff Carole , Fischer Michael , Reynolds Samuel , Snyder Gabrielle , Thakkar Payal , Aoun Elie , Farah Tony , Thakkar Shyam , Farah Katie 
Published: October 2019

INTRODUCTION:
Our Health Network and insurance provider collaborated to focus on a Care Model for colorectal cancer (CRC) screening to address barriers to screening. This Care Model corresponds to a manner in which healthcare services are delivered while outlining best practices and services to patients as they progress through stages of colon cancer (Figure 1). Well-known barriers to CRC screening include lack of transportation, lack of primary care physician (PCP) involvement and education, apprehension about the prep and/or complications, and certain ethnicities.

METHODS:
Our Health Network and insurance provider worked together on the GI Care Model to address underutilization of CRC. The team interviewed PCP practices in the region to identify their processes for screening. The team performed a geographical analysis identifying screening rates for Western PA and the city of Pittsburgh by zip code and socioeconomic status. Transportation status, PCP status, age, and ethnicity as well as socioeconomic status were evaluated. The team then used this information to implement initiatives targeted at reducing and eliminating these barriers.

RESULTS:
PCPs expressed lack of updated knowledge regarding the latest colon cancer guidelines and challenges in scheduling a procedure. 122 healthcare professionals attended the webinar series in the first quarter. Feedback was overwhelmingly positive with requests for further education on a quarterly basis. Screening rates were higher if a patient had a PCP vs no PCP (Table 1). A Best Practices Alert was generated and sent by massmail to all healthcare practitioners across the region which outlined the latest recommendations with respect to screening. Difficulties in scheduling were optimized by providing flow diagrams of the scheduling process. We found that the strongest correlation to a lack of screening was lack of a vehicle (Table 2). The PALS (People Able to Lend Support) volunteer program was implemented for patients who had no vehicle. A patient education program (Doc Talks) was also offered to patients in the community at selective health insurance retail stores. Opportunity to answer questions and address fears of procedure were discussed.

CONCLUSION:
The GI Care Model has made significant progress in increasing awareness, education, access, and identification of common barriers which contribute to underutilization of CRC screening in our region. We will be addressing the barriers by ethnicity in future months as part of our Care Model.
248 Analysis of Antiplatelet/Anticoagulant Agents Exposure in Patients With Positive Fecal DNA Test
Authors: Inaganti Anupama , Fahed Julien , Fahed Gracia , Huq Nadia , Affi Aboud 
Published: October 2019

INTRODUCTION:
Due to the increased risk of gastrointestinal bleeding (obscure and overt), antiplatelet/anticoagulant agents may increase the chances of a positive stool DNA test, leading in an increased false positive rate. To date, there have been no published studies to evaluate if anticoagulants/anti-platelet agents can affect the results of the stool DNA test.

METHODS:
A retrospective chart review of 1413 patients who had a positive stool DNA followed by documented colonoscopy was performed. Two patients were excluded because of finding of “other carcinoma.” Attention was given to the patient's medication list at the time of the test. All patients on clopidogrel or other antiplatelet agents, warfarin, direct thrombin inhibitors were included in the analysis and patients on aspirin were excluded. Patients who met the inclusion criteria were divided in 2 groups. Group one (1) included patients who were not exposed to antiplatelet/anticoagulant therapy while group two (2) included patients who were exposed to at least 1 antiplatelet/anticoagulant therapy. 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. Non-advanced 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 1411 patients included in the study, 1221 (86.53%) patients were not exposed to antiplatelet/anticoagulant agents while 190 (13.47%) were exposed to at least one antiplatelet/anticoagulant agent. Colonoscopy findings between group 1 and group 2 were compared. “Adenocarcinoma” was found in 1.64% vs. 2.11% respectively (P = 0.55). “Advanced adenoma” was found in 23.01% vs. 27.89% respectively (P = 0.14). “Non-advanced adenoma” was found in 28.67% vs. 34.74% respectively (P = 0.09). Finally, no adenomas were found in 39.39% vs. 28.95% respectively (P = 0.006), which was statistically significant.

CONCLUSION:
Previously published studies noted higher prevalence of colorectal neoplasms in patients with coronary artery disease. In our study, patients who are exposed to antiplatelet/anticoagulant therapy were found to have about 10% more cancerous/precancerous lesions on colonoscopy which could be due to higher cardiovascular comorbidities in patients on this therapy.
255 Yield of Non-Lynch Gene Mutations During Testing for Lynch Syndrome
Authors: Davis Christian , Harrigan Jack , Chauhan Mahak , Hejazi Reza , Buckles Daniel , Olyaee Mojtaba , Kennedy Kevin , Madan Rashna , Bansal Ajay 
Published: October 2019

INTRODUCTION:
Multigene panels are commonly used for genetic testing when Lynch syndrome is suspected. However, the data about the relative yield of Lynch vs. non-Lynch mutations are sparse.

METHODS:
In this retrospective, single-center study, all patients with a diagnosis of colon or uterine cancer between January 1, 2016 and June 30th, 2018 were included. The patients were identified using search in the pathology database for SNOMED codes. Additionally, the search results of SNOMED codes were tallied with the cancer center database to capture all patients with colon cancer. A structured RedCap electronic database was created to systematically abstract data about demographics, location and stage of colon cancer, PREMM5 scores, genetic testing and a detailed 3-generation family pedigree. After being screened for Lynch syndrome using immunohistochemical assays or PCR-based detection of microsatellite instability, patients with abnormal results underwent genetic testing using well-established multi-gene commercial assays. The yields of Lynch and non-Lynch syndromes were compared. Statistical comparisons were performed using Chi-square test for categorical variables and Student's t-test for numerical variables.

RESULTS:
A total of 737 participants (whites 84.1%, mean age of 62.7) were included. A diagnosis of Lynch syndrome was made in 21 of the 737 participants (2.85%). Non-Lynch mutations were detected in 12 of the 737 participants (1.63%). When colon and uterine cancers were analyzed separately, non-Lynch mutations were detected in 2.1% and 1.5% of participants respectively (Table 1). The non-Lynch genetic mutations detected included: APC, MAP syndrome, CHEK2, BRCA1, BRCA2, MUTYH, PALB2, AXIN2, SMARC4, and NTLH1.

CONCLUSION:
Germline testing has a significant yield of non-Lynch mutations in patients suspected to have Lynch syndrome. Our data support the current practice of multigene panels to define syndromic cancer risk.
259 Open Access Colon Cancer Screening With Optical and Virtual Colonoscopy
Authors: Curtis Stephen , Tritsch Adam 
Published: October 2019

INTRODUCTION:
Despite proven efficacy in improving mortality from colorectal cancer (CRC), CRC screening remains underutilized in the U.S. with nearly 1/3 of eligible patients not screened. Open access colonoscopy (OAC) allows for patients at low-risk for endoscopic complications to receive a colonoscopy without a pre-procedural visit. Although the ASGE has published guidelines on enacting an OAC program, there has been little published on the yield of such a program.

METHODS:
At Walter Reed National Military Medical Center, we enacted an OAC program in 2014. Patients due for CRC screening or surveillance can arrange a procedure by an online form. Our schedulers' review all forms, and patients reporting concerning symptoms, sedation limiting comorbidities, or who are age < 45 or > 75 have a clinic visit prior to their procedure. The remainder of patients have their forms reviewed by a gastroenterologist for suitability and are scheduled for colonoscopy or computed tomographic colonography (CTC).

RESULTS:
Prior to expanding Walter Reed's OAC program to other military hospitals in the NCR, 10,676 total screening requests were made. 48.7% were male, 53.4% were Caucasian, 18.0% were African American. The requested screening method was CTC in 19.1% of submitted forms. Of patients who fell outside the 45–75 age range, 11.4% were under the age of 45, and 1.2% were over the age of 75. Half of the patients using the OAC program had a previous screening exam, and a total of 12.7% reported a family history of CRC. Since incorporating other military hospitals in the NCR, 2,882 screening forms have been completed: 33.6% were male, 35.1% were Caucasian, 14.6% were African American, 14.9% requested a CTC, 5.1% were under the age of 45, 1.0% were over the age of 75, 33.3% had a previous screening, and 9.2% had a family history of CRC. Prior to incorporating the NCR, 20.4% of patients were referred for a clinic visit based on answers in their form, and another 6.0% were referred for a clinic visit after provider review. After the incorporation, 16.4% were referred for a clinic visit.

CONCLUSION:
By avoiding unnecessary clinic visits for patients needing a colonoscopy, OAC programs reduce wait times for colonoscopies and increase availability in gastroenterology practices to see symptomatic patients. Our program in a single payer model, analyzed across two different catchments, shows that over 80% of pre-procedural visits can be avoided by using a questionnaire.
264 The Differences in Prevalence, Distribution, and Detection Rates of Colonic Polyps Between Genders
Authors: Alomari Mohammad , Al Momani Laith , Sarmini Muhammad Talal , Khazaaleh Shrouq , Nehme Fredy , Wadhwa Vaibhav , Thota Prashanthi N. , Sanaka Madhusudhan R. 
Published: October 2019

INTRODUCTION:
Gender disparities in colorectal cancer (CRC) incidence and mortality are well recognized in the literature with polyp characteristics and location being amongst some of the most important factors contributing to these disparities. Prior studies have shown an increased prevalence of proximal adenomas and CRC in women. We aimed in this study to compare the distribution and the prevalence of colonic polyps between both genders, as well as evaluating gender-specific lesion detection rates.

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), sessile serrated polyp detection rates (SSPDR) and polypectomy rates (PR) were calculated and compared using t-tests. Proximal colon was defined as the cecum, ascending, and the transverse colon.

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. A total of 652 (15.7%) had excellent preparation, 2675 (64.4%) had good preparation, while 824 (19.9%) had fair preparation (Table 1). Of the 3476 polyps found, 1660 (47%) polyps were found in the proximal colon. Generally, males had more polyps and adenomas all throughout the colon (Table 2). Compared to males, females had less proximal polyps per patient (0.35 ± 0.24 vs. 0.50 ± 0.33; P < 0.001), less proximal adenomas per patient (0.22 ± 0.18 vs. 0.35 ± 0.26, P < 0.001), and less overall large adenomas (>1 cm) per patient (0.05 ± 0.07 vs. 0.09 ± 0.13, P < 0.008). In males, endoscopists had better overall ADR (32.7 ± 14.7 vs. 22.0 ± 12.7, P < 0.001), PR (51.9 ± 17.9 vs. 40.3 ± 18.8, P < 0.001), and SSPDR (22.6 ± 15.7 vs. 16.6 ± 13.7, P < 0.001) (Table 3).

CONCLUSION:
Our study demonstrates a significant difference in polyp distribution based on patient sex. This is contradictory to what has previously been reported in the literature with more proximal polyps noted in female patients. We believe the advancement in colonoscopy techniques and training in addition to the increased awareness of female sex association with right-sided tumors contributed to this topographic distribution shift of colonic polyps. Although the involved endoscopists met the recommended national ADR benchmarks, women had lower ADR reflecting the differences in the adenoma prevalence in these populations.
279 Rate of Colorectal Neoplasia in Patients With Hodgkin Lymphoma
Authors: Abu-Sbeih Hamzah , Ali Faisal , Coronel Emmanuel , Lee Hun Ju , Pande Mala , Bresalier Robert , Raju Gottumukkala , Wang Yinghong 
Published: October 2019

INTRODUCTION:
Survivors of Hodgkin lymphoma (HL) are at increased risk of breast, lung, thyroid, stomach, pancreas, and colon cancer. However, information on the utility of endoscopic screening for colon cancer in this population is limited. The adenoma detection rate (ADR) reported in the literature is 25–35% in patients between 50 and 70 years of age. We aimed to describe the ADR in patients previously treated for HL to determine the appropriate timing of colonoscopy screening initiation.

METHODS:
We retrospectively studied patients with HL who underwent colonoscopy after HL diagnosis between 2000 and 2017. Patients with a history of colorectal cancer were excluded.

RESULTS:
Of the 4190 patients who were diagnosed with HL during the study period, 251 underwent colonoscopy. Eighty (32%) patients had 151 colonic polyps. About a third of the polyps (45 polyps, 30%) exhibited high-grade dysplasia, and invasive colon adenocarcinoma was found in 10 patients (Table 1). Patients with the nodular sclerosing subtype of HL had a significantly lower ADR than other subtypes (P = 0.002) (Table 2). The ADR was 5% in patients younger than 35 years (n = 64), 23% in patients between 35 and 40 years of age (n = 22), 39% in patients between 40 and 50 years of age (n = 51), and 46% in patients older than 50 years (n = 114) (Figure 1). The median time from HL diagnosis to first endoscopy was 3 years (interquartile range [IQR], 1–6 y). Thirty-seven patients (15%) underwent repeat colonoscopy. The ADR for repeat colonoscopies was 41%.

CONCLUSION:
The ADR in patients with HL is higher than the ADR of the general population reported in the literature, particularly in patients younger than 50 years of age. These data suggest that a previous diagnosis of HL should be considered as a risk factor warranting colonoscopy screening before 50 years of age.
282 Risk Factors for Colorectal Cancer in Patients Under 50: A Retrospective Study
Authors: Gellatly Matthew , Crockett Seth 
Published: October 2019

INTRODUCTION:
Colorectal cancer (CRC) incidence and mortality rates are rising in patients under age 50 for uncertain reasons. This study aims to identify risk factors and tumor characteristics of younger CRC patients aged 19–49 (Y-CRC), compared to a control group of CRC patients aged 50–60 (CRC-50+).

METHODS:
From a clinical and administrative database at a single institution, we identified patients with an initial CRC diagnosis between 2010–2012. Only histologically confirmed primary colon adenocarcinomas were included. Clinical and demographic characteristics were extracted via chart review. Bivariate and multivariable analyses were performed to compare Y-CRC and CRC-50+ groups.

RESULTS:
A total of 190 patients met our criteria (100 CRC = 50+, 90 Y-CRC). Most patients were white (123 patients, 64.7%), and 49 were black (25.8%). There were 90 female patients (47.4%). The average body mass index (BMI) was 27.1 kg/m2. 64 patients (33.7%) were current smokers. Family history of CRC or polyps was noted in 54 patients (18.4%). History of inflammatory bowel disease (IBD) was present in 11 patients (5.8%). The 12 patients (6.3%) with CRC-predisposing genetic syndromes were excluded from case-control analysis. We found no differences in BMI between groups (P = 0.8). There was a substantially higher proportion of Hispanic patients in Y-CRC group versus CRC-50+ group (13.9% vs. 0%, P < 0.01). Diabetes was less common in Y-CRC than CRC-50+ (7.6% vs. 18.2%, P = 0.04). There was no statistically significant difference between groups in smoking history or family history of CRC/polyps. Although IBD was more common in Y-CRC (8.9% vs. 4.0%), the difference was not statistically significant (P = 0.2). Rectal cancers were slightly more common in Y-CRC (55.1% vs. 47.5%), but this was not statistically significant. Y-CRC patients were more likely to present at later stages and with synchronous lesions, compared to CRC-50+ cases. On multivariable analysis, Y-CRC was associated with Hispanic ethnicity and inversely associated with diabetes, after controlling for other factors (Table 2).

CONCLUSION:
Aside from a higher proportion of Hispanic ethnicity and lower proportion of diabetes among Y-CRC cases, the Y-CRC and CRC-50+ groups were comparable. We found no evidence of an association between family history, obesity or smoking with Y-CRC cases. Further work is needed to explore these and other potential risk factors for Y-CRC.
298 Positive Predictive Value of Multitarget Stool DNA Testing for Colorectal Cancer Screening
Authors: Alimirah Maryam , Naffouj Sandra , Askar Firas , Sadiq Omar , Jinjuvadia Raxitkumar , Siddiqui Yousuf 
Published: October 2019

INTRODUCTION:
Colorectal cancer (CRC) remains one of the leading causes of death in the United States, however only 60% of the eligible screening population is up-to date on screening. The suboptimal rate of participation in CRC screening has paved the way for less invasive screening modalities such as the multitarget stool DNA test, which is reportedly 92.3% sensitive and 89.8% specific at identifying cancerous lesions in an adult population at average risk for CRC. Anecdotal reports have brought the specificity of this test into question. We conducted a retrospective study at our tertiary care center to assess the utility of multitarget stool DNA testing in diagnosing cancerous and pre-cancerous lesions.

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, anti-platelet/anticoagulation use, and endoscopic findings. All patients with subsequent surveillance colonoscopies were included. Advanced adenomas were defined as tubular or serrated adenomas with size greater than 1 cm or tubulovillous adenomas of any size. Statistical analysis was performed using R 3.6.0.

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. Average size of advanced adenomas was 13.3 mm ± 11.4. Low risk lesions measured 6.82 mm ± 4.66. We found a positive predictive value (PPV) of 53.4% for an advanced adenoma or adenocarcinoma. In subgroup analysis, 46.4% of aspirin users had advanced adenomas on colonoscopy, compared to 65.1% of patients on factor Xa inhibitors. 62.1% of clopidogrel users had advanced adenomas.

CONCLUSION:
Our experience with Multitarget Stool DNA Testing varies from that demonstrated in literature. Initial multicenter studies demonstrate a specificity of 87% with sensitivity of 92% for adenocarcinoma and 69% for advanced adenomas. This translates to a PPV of 87.6% and 84% respectively. In comparison, our results demonstrated a PPV of 53.4%. Further studies are required to determine if these differences also extend into the sensitivity of the test and its utility as a screening test for colorectal cancer.