bluuebunny/crossref_metadata_2025_split huggingface dataset:
231 Low Prevalence of Gastric and Duodenal Neoplasia in Patients With Colon Polyposis of Unknown Etiology
Authors: Farah Filsan , Kruger Andrew , Pearlman Rachel , Hampel Heather , Hinton Alice , Stanich Peter P. 
Published: October 2019

INTRODUCTION:
Patients with ≥10 cumulative colorectal adenomas without identified APC or MUTYH mutations are labeled as colon polyposis of unknown etiology (CPUE). Two small series of CPUE patients compiled prior to widespread multi-gene panel genetic testing indicate that duodenal screening of CPUE patients may be high yield, but this has not been incorporated into guidelines. Our aim was to investigate the prevalence of neoplastic lesions on screening upper endoscopy (EGD) in CPUE patients.

METHODS:
Retrospective review of patients followed in the Hereditary and High-Risk GI Clinic for CPUE from 8/2014 through 3/2019 was performed. Inclusion criteria included age ≥18 years, ≥10 cumulative colorectal adenomas, unrevealing genetic testing including at least APC and MUTYH and receiving screening EGD (baseline EGD with ampullary visualization was a standard recommendation after the diagnosis of CPUE). Exclusion criteria included pathogenic genetic mutation in a hereditary cancer gene, history of gastric or duodenal neoplasia, serrated polyposis syndrome or a history of abdominal radiation or chemotherapy.

RESULTS:
Study criteria were met by 46 patients (31 M/15 F) with median age of 67 (range 30–82). The median cumulative adenoma count was 24 (range 10–290), with 17 (37%) having 10–19 adenomas, 26 (57%) with 20–99 and 3 (7%) with ≥100. A history of colorectal cancer was noted in 6 patients (13%) and 8 (17%) had colectomy (2 partial, 4 subtotal, 2 total). Multi-gene panel testing was performed in 42 patients (91%), with variants of uncertain significance in polyposis genes for 6 patients (13%). Screening EGD included ampullary visualization in all but 1 patient. Neoplastic findings were found in 2 patients (4%), with 1 patient with gastric adenocarcinoma at age 55 and 1 patient with ampullary adenoma at age 55. No gastric or duodenal adenomas were identified in the cohort. In the subset of patients ≤60 years, the prevalence of neoplastic findings was 13% (2/16). In the subset of patients with ≥20 adenomas, the prevalence was 7% (2/29). Further EGD after index procedure was performed in 16 patients during study period without identification of additional neoplasia.

CONCLUSION:
There was a lower prevalence of gastric and duodenal neoplasia in patients with CPUE that primarily received multi-gene panel testing than previously reported, although there may be higher yield in screening younger patients. A large, multi-center study is needed to clarify the optimal management of CPUE patients.
239 Detection Rate of Serrated Adenomas in the Screening Colonoscopy Population
Authors: Ali Birmaji , Fahim Peter , Steinbrunner Jenni , Kindel Robert 
Published: October 2019

INTRODUCTION:
Colorectal cancers arise from 3 distinct pathways: the adenoma to carcinoma pathway, the Lynch syndrome pathway, and the serrated pathway. The serrated pathway is characterized by neoplastic transformation of serrated polyps, which are classified into hyperplastic polyps (HP), sessile serrated adenomas (SSA) and traditional serrated adenomas (TSA). HPs distal to descending colon have no malignant potential, while SSA & TSA are precancerous lesions. SSA are the major precursor lesions responsible of cancer via serrated pathway. SSA are difficult to differentiate histologically from HPs in the proximal colon. Recent studies have shown SSAs to be more common than previously believed. Our study purpose is to determine the prevalence of SSAs, variability amongst endoscopists in detecting serrated adenomas, and the identification of significant risk factors.

METHODS:
Patients undergoing screening colonoscopy were enrolled into this prospective cross-sectional study conducted at a tertiary community teaching hospital and an outpatient endoscopy unit. Screening colonoscopy was defined as the first colonoscopy performed in an asymptomatic patient without risk factors between the age of 50 and 80. Patients reported as having poor bowel preparation were excluded from the study. Statistical analysis was conducted to determine the overall detection rate of serrated adenomas and assess the variability among 6 endoscopists.

RESULTS:
Of the 263 screening colonoscopies, the serrated adenoma detection rate was 12.2% (95% CI 8.2–16.2%) with a wide range of variability amongst the 6 endoscopists from 3.4–15%. The total serrated polyp detection rate, which includes SSA, TSA and proximal HPs, was 13.7% (95% CI 9.5–17.9%) with a range of 10.2–17.5% amongst endoscopist. The adenoma detection rate for the endoscopists was 46.4% (95% CI 40.4–52.4%). Study results revealed serrated polyps have a significant association with Caucasians (P = 0.002), while adenomatous polyps are significantly associated with males (P = 0.001) and current smokers (P = 0.01).

CONCLUSION:
The increasing prevalence of SSA found in recent studies seems directly related to improving histologic distinction between SSA and HPs. Despite this improvement, the reported prevalence is still highly variable. Our study found that by using a total serrated polyp detection rate we were able to reduce variability amongst endoscopists, and a significant association between Caucasians and development of serrated polyps.
242 Demographic and Historical Risk Factors Associated With Incomplete, Missed, and Cancelled Colonoscopies
Authors: Castillo Michael , Gonzalez Adalberto , Hussain Ishtiaq , Wadhwa Vaibhav , Schneider Alison 
Published: October 2019

INTRODUCTION:
Access to colonoscopy is critical for colorectal cancer screening. Cancelled colonoscopy appointments have a major impact on overall healthcare costs, provider workflow, and delays in colorectal cancer screening and diagnosis. We aimed to discover individual and systemic factors associated with the occurrence of incomplete, missed or cancelled colonoscopy appointments at our institution.

METHODS:
This was a retrospective observational study using the Cleveland Clinic Florida database. Patients scheduled for screening or diagnostic colonoscopy from January to June 2018 were included. There were two case groups: those that missed or cancelled colonoscopy appointments and those that had incomplete colonoscopies due to poor bowel preparation. A control group consisted of a random sample of 200 patients that had completed colonoscopies during the same time period. We excluded patients that underwent therapeutic colonoscopies. We performed descriptive analysis within each group, univariate analysis between the control group and case groups, and odds ratio. We used a 95% CI and P-values of less than 0.05 for statistical significance.

RESULTS:
4,499 colonoscopies were scheduled from January to June 2018. There were 369 (8.2%) missed/cancelled colonoscopies and 117 (2.6%) incomplete colonoscopies. Control group included a random sample of 200 completed colonoscopies. The total sample size was 686. Factors associated with a decreased risk of missed colonoscopies included white race (OR 0.56; P = 0.001), history of polyps (OR 0.52, P < 0.001), previous colonoscopy (OR 0.32; P < 0.0001), diagnosis of IBD (OR 0.21, P = 0.001), and married status (0.52; P = 0.001) (Table 1). Patients of black race (OR 2.1; P = 0.01) and patients with international addresses (OR 2.34; P = 0.04) were more likely to have incomplete colonoscopies (Table 2). Incomplete colonoscopies were more likely to be performed and re-scheduled than cancelled colonoscopies (67.5% vs. 44%; P < 0.001). Monday was the most common day for cancellations (12.6%). Difficulty understanding or tolerating bowel preparation (39.2%) was the most common reason for cancellation (Figure 1).

CONCLUSION:
Patient demographics, particularly patients visiting from international locations, were major risk factors for missed and incomplete colonoscopies. Many patients appeared to have difficulty understanding bowel preparation instructions. Future efforts should be made to focus on improving bowel preparation education. This will lead to improvement in healthcare utilization.
246 Helicobacter pylori Infection Increases the Risk of Colorectal Polyps: A Large Scale Case-Control Study
Authors: Kawahara Yoshinari , Kodama Masaaki , Mizukami Kazuhiro , Saito Tomoko , Hirashita Yuka , Sonoda Akira , Fukuda Kensuke , Matsunari Osamu , Okamoto Kazuhisa , Ogawa Ryo , Okimoto Tadayoshi , Murakami Kazunari 
Published: October 2019

INTRODUCTION:
Persistent Helicobacter pylori (H. pylori) infection begins during childhood and can cause peptic ulcers and gastric cancer. It can also cause extra-gastric organ disease, including idiopathic thrombocytopenic purpura. Although some studies have indicated a correlation between H. pylori infection and the risk of colorectal neoplasms, these findings have not been consistent and are controversial. This case-control study aimed to investigate the association between H. pylori-associated endoscopic gastric mucosal atrophy (GMA) and colorectal polyp occurrence.

METHODS:
Records of 7394 participants who underwent colonoscopy examinations from August 2008 to July 2018 were reviewed retrospectively. Saved images of endoscopic examinations were used to evaluate the colorectal polyps and GMA. Adjusted odds ratios for predictors of colorectal polyps were computed by using the multiple logistic regression model.

RESULTS:
A total of 2404 subjects were registered; 1565 (65.1%) were in the GMA-positive group and 1138 (47.3%) had colorectal polyps. The multivariate analysis adjusted by age, sex, smoking habits, alcohol habits, serum lipid levels, hemoglobin A1c (HbA1c), blood pressure, and body mass index indicated that patients in the GMA-positive group more frequently had colorectal polyps compared with patients in the GMA-negative group (odds ratio [OR], 3.27; 95% confidence interval [CI], 2.68–4.01; P < 0.001). An analysis of the association between GMA degree and colorectal polyp status indicated that, compared with mild GMA, severe GMA was associated with a higher risk of proximal colon polyps (OR, 1.47; 95% CI, 1.05–2.07; P = 0.024) and two or more colorectal polyps (OR, 1.80; 95% CI, 1.30–2.49; P < 0.001).

CONCLUSION:
Colonoscopy examination is useful for discovering colorectal disease, including polyps; however, the examination is more burdensome than esophagogastroduodenoscopy for patients because of the required preparation and invasiveness. This study showed H. pylori-associated GMA found during endoscopy indicated an increased risk for colorectal polyps. Moreover, it also showed severe GMA indicated risks for proximal colon polyps and multiple polyps. These results allow physicians to recommend colonoscopy examinations for specific patients.
247  Automatic Polyp Detection System: Man Versus Machine Towards a Collaborative Colonoscopy
Authors: Beard Jasna I. , Kahloon Arslan , Siersema Peter , Gross Seth , Jacob Harold 
Published: October 2019

INTRODUCTION:
Missed lesions are considered a major cause of interval cancer of the colon. The new Automatic Polyp Detection System (APDS) from Magentiq Eye was developed to enhance the ability of endoscopists to detect polyps. It is designed for offline use with future real-time applications. The system uses recorded colonoscopy videos to assess endoscopist performance against the APDS. The APDS reviews the videos to generate a computerized automatic signature of polyps; a separate screen then shows the corresponding “heat map' contour of areas suspicious for presence of polyps (see Figure 1).

METHODS:
In this proof-of-concept study, the performance of the trained system was compared with a known testing database of 35 videos (each sequence approximately 30 seconds and 1000 frames). Overall, the testing database included 35,290 frames, with polyps found in the right colon (cecum and ascending colon, 10), transverse colon (5), and left colon (sigmoid and rectum, 20). Of the 35, 33 polyps were sessile and 2 were pedunculated; sizes ranged from less than 3 mm (10), 3 to 6 mm (16), 6 to 10 mm (5), and over 10 mm (4). Our goal was to define the optimal system working point in terms of sensitivity and specificity to detect polyps present in at least 3 consecutive frames. Physicians reviewed videos for polyps that were missed by the APDS and compare it with those missed by the endoscopists.

RESULTS:
The best working point of the system showed 88% sensitivity with 98.4% specificity (0.016 false positive rate). This resulted in a system polyp detection rate (SPDR) of 85.8% with 5 missed polyps. Missed lesions were found in the ascending (2), transverse (2), and descending (1) colon. All were sessile with sizes of less than 3 mm (1), 3 to 6 mm (3), 6 to 10 mm (1). The physicians missed 4 polyps found in the transverse colon (3) and descending colon (1). All polyps missed by physicians were sessile with sizes of less than 3 mm (1), 3 to 6 mm (2), and 6 to 10 mm (1). Only one polyp was missed both by the APDS and the physician.

CONCLUSION:
Given that only one polyp was missed both by the APDS and the endoscopists, the APDS demonstrated the potential to behave as a complementary tool during colonoscopy in order to alert the endoscopist to lesions that may otherwise be missed, aiming to decrease the incidence of interval colon cancers.
250 Has Endoscopic Screening for Colon and Rectal Cancer Reached an Inflection Point?
Authors: Meade Charles , Hansel Stephanie 
Published: October 2019

INTRODUCTION:
There are six currently approved screening modalities for colorectal cancer (CRC) as of 2016 United States Preventative Services Task Force guidelines. We sought to model what changes in current screening practice regarding choice between endoscopic and non-endoscopic testing would have to occur to drive a significant (10%) decrease in population-wide endoscopic procedures done as a result of CRC screening.

METHODS:
Published models of endoscopic procedural rates for all six approved screening methods were integrated with National Health Interview Survey data on screening compliance and reported utilization rates of currently approved screening modalities. A simulated population of 1000 screening-naïve patients was modeled over the guideline recommended period of 25 years (age 50–75). Individuals within the model could choose endoscopic or non-endoscopic screening, but were not allowed crossover between the two groups. Positive non-endoscopic screens were referred for endoscopy and continued on endoscopic screening thereafter. Population-wide total predicted endoscopic procedures were calculated using variables reflecting current screening practices. Choice of endoscopic and non-endoscopic screening within the population was then modified to estimate the increased adoption of non-endoscopic screening that would be necessary to drive an overall 10% reduction in total CRC screening related endoscopic screening procedures.

RESULTS:
For a simulated population of 1,000 screening-eligible and screening-naïve adults, screening activity mirroring recent compliance rates and choice of modality type generates approximately 2,612 endoscopic procedures over the population's screening lifetime. If 20% more screened patients choose non-endoscopic screening relative to current rates and overall rates of screening compliance remain stable then the number of total endoscopic procedures done for CRC screening drops by 10% (2,348).

CONCLUSION:
Currently, non-endoscopic approaches to CRC screening represent <10% of screened patients. Our data shows that if a relatively small increase in utilization of non-endoscopic screening strategies occurs then a significant reduction in the number of endoscopic procedures performed for screening purposes are likely. Such a change in screening practices might be an avenue towards reducing population screening costs, justifying initial screening at a younger age, and improving access to care.
252 Patient and Provider Risk Factors for Sessile Serrated Polyp and Adenoma Detection on Screening Colonoscopy
Authors: Zhou Margaret , Krigel Anna , Lebwohl Benjamin 
Published: October 2019

INTRODUCTION:
Sessile serrated polyps (SSPs) have been increasingly recognized as precursors to colorectal cancer (CRC). Unlike adenoma detection rate (ADR), there is currently no agreed-upon benchmark for SSP detection rate (SSPDR), and data on factors that impact SSP detection are limited. We aimed to identify patient, endoscopist, and procedural factors associated with SSP and adenoma detection.

METHODS:
We used a single-center electronic endoscopy database to identify all patients ages ≥50 years who underwent outpatient screening colonoscopy from January 1, 2012 to June 30, 2018. We excluded patients with a personal history of inflammatory bowel disease or colorectal neoplasia, or who underwent colonoscopy performed by a provider with fewer than 50 colonoscopies over the study period. Univariate chi-square analysis was used to determine patient, endoscopist, and procedural-related factors associated with SSP or adenoma detection on colonoscopy.

RESULTS:
We identified 10,538 unique patients who underwent colonoscopy performed by 28 endoscopists. SSPs were detected in 233 cases (2.2%), and adenomas were detected in 3,066 cases (29.1%). On univariate analysis, race and any smoking history were significantly associated with SSP detection (P = 0.044 and P = 0.054, respectively; see Table 1). Higher endoscopist ADR and greater mean withdrawal time were also associated with higher likelihood of SSP detection (P = 0.019 and P = 0.007, respectively). There was a significant trend towards increased SSP detection in colonoscopies performed in more recent years (P < 0.001). While endoscopist gender was not associated with SSP detection on univariate analysis, female endoscopists had significantly higher ADR (35.5%) compared to male endoscopists (28.2%, P < 0.001). ADR for cases with trainees present was 33.6% compared to 28.1% in cases without trainees (P < 0.001).

CONCLUSION:
In patients undergoing screening colonoscopy, SSPDR was significantly higher in procedures performed by physicians with higher ADR or greater mean withdrawal time, and in procedures performed in more recent years. Patient tobacco use history and race were also associated with SSP detection. These findings may help in establishing SSPDR as a quality metric for screening colonoscopy.
256  Lowering the PREMM5 Model Threshold to 2.5% Identified the Majority of Patients With Lynch Syndrome
Authors: Davis Christian , Harrigan Jack , Chauhan Mahak , Hejazi Reza , Buckles Daniel , Saeed Anwaar , Kennedy Kevin , Madan Rashna , Bansal Ajay 
Published: October 2019

INTRODUCTION:
The Prediction Model for Gene Mutations (PREMM) is a widely used tool for predicting the probability of Lynch syndrome but the predictive power of various cutoffs for the risk scores is unclear.

METHODS:
In this retrospective, single-center study, all patients with a diagnosis of colorectal or uterine cancer between January 1, 2016 and June 30th, 2018 were included. The patients were identified using specialized text-based search of the pathology lab information systems. Additionally, the search results were tallied with the local NCI-designated 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. All patients underwent screening for Lynch syndrome using immunohistochemical or microsatellite instability based testing. Final diagnoses in patients with abnormal screening was based on well-established commercial assays. The yield of Lynch syndrome was compared across three categories of PREMM5 scores: <2.5%, 2.5–4.9%, ≥5%. These scores reflect pre-test probability of Lynch syndrome. Statistical comparisons were performed using ANOVA.

RESULTS:
Of a total of 737 patients with either colon or uterine cancer, the final diagnosis of Lynch syndrome was made in 2.8% (21/737). The mean age at the time of cancer diagnosis across the three PREMM categories (<2.5%, 2.5–4.9%, ≥5%) was progressively lower: 68.9 ± 9.0 vs. 54.7 ± 9.5 vs. 48.2 ± 15.2, P < 0.001. Table 1 outlines the characteristics of the three groups. Table 2 describes the performance characteristics of different cutoffs of PREMM5 criteria.

CONCLUSION:
In patients with colorectal or uterine cancers, PREMM cutoff value of 2.5% identified the majority of patients with Lynch syndrome with a modest increase in the number needed to screen. Therefore, a PREMM score of 2.5% should trigger genetic testing.
260 Exogenous Insulin and Risk of Colorectal Adenomas in Type I Diabetes
Authors: Shieh Christine , Moleski Stephanie 
Published: October 2019

INTRODUCTION:
The recent update for colorectal cancer screening to begin earlier at the age of 45 reinforces the need to better risk stratify populations for screening of colorectal adenomas which are precursor lesions to tumor formation. Prior studies suggest an association between Type II diabetes and risk of colon cancer with the underlying theory that progressive insulin insensitivity in addition to insulin use leads to hyperinsulinemia which promotes colorectal carcinogenesis. There is lack of data on risk of adenomas with isolated exogenous insulin use which is reflected in Type 1 diabetes. In this single center retrospective study, we examined the adenoma detection rate in Type I diabetics to better delineate the isolated risk of exogenous insulin use on developing colon cancer.

METHODS:
Charts for Type 1 diabetic patients spanning the age of 30–80 were reviewed. Age at first colonoscopy, gender, race, BMI, smoking history, family history of colon cancer, number of polyps, insulin use, and HbA1c were collected. Age and gender matched non-diabetics were used as control. To further control for confounding factors, multivariate analysis using logistic regression was performed.

RESULTS:
As only 5% of diabetics are Type 1, our preliminary results included forty-eight Type 1 diabetics matched with respective controls who underwent colonoscopy. Multivariate analysis showed a significant difference in adenoma detection rate between control and Type 1 diabetics (33% vs 52%, P = 0.017; OR 3.25; CI 1.28–8.95). This difference was significant (P = 0.033) in both the younger age group (<60 years of age) and the older age group (60–80 years of age). Within the Type 1 diabetes group, there was no significant association between adenoma detection and HbA1c level. There was also independent association between adenoma detection and male gender (P = 0.041), increased age (P = 0.052), and positive smoking history (P = 0.098) which is consistent with previously known data.

CONCLUSION:
Our study thus far suggests that Type 1 diabetics have an increased risk of colorectal adenomas spanning a wide range of age groups and that this difference is not affected by the HbA1c level, which is a marker of insulin resistance. Having controlled for a variety of factors, our findings suggest that this increased risk of adenomas may be influenced by long-term exogenous insulin use, as Type 1 diabetics become reliant on this at an early age. These findings will be tested for validation in a larger cohort.