Sa1471 Hematochezia Predicts Large Polyps in Patients 40 to 49 Years Old

Sa1470 The Optimal Endoscopy Interval for Detecting Early Gastric Neoplasms Chan Hyuk Park*, Eun Hye Kim, Hyunsoo Chung, Hyuk Lee, Jun Chul Park, Sung Kwan Shin, Yong Chan Lee, Sang Kil Lee Department of internal medicine, Yonsei University College of Medicine, Seoul, Republic of Korea Aim: The optimal interval between endoscopic examinations for detecting early gastric neoplasms, including gastric adenomas, has not previously been studied. We aimed to clarify the optimal interval between endoscopic examinations for the early diagnosis of both gastric cancers and adenomas. Methods: The interval between endoscopic examinations was investigated using a questionnaire survey administered by interview at outpatient clinics or by telephone poll for patients who had been treated for gastric neoplasms between January 2008 and August 2013. A total of 846 patients were divided into 5 groups according to the duration between the penultimate endoscopy and a diagnosis of a gastric neoplasm. Results: In total, 197, 430, and 219 patients were diagnosed with gastric adenoma, early gastric cancer, and advanced gastric cancer, respectively. In multivariate analysis, the proportion of gastric neoplasms treated with endoscopic submucosal dissection was significantly higher in the 12 months or less, 12-24 months, and 24-36 months endoscopy interval groups than in the no endoscopy within 5 years group (all P! 0.001). In addition, the proportion of advanced gastric cancers was significantly lower in the 12 months or less and 12-24 months endoscopy interval groups than in the no endoscopy within 5 years group (all P! 0.001). Conclusion: On the basis of these findings, we recommend biennial endoscopic screening for gastric neoplasms in order to increase the proportion of lesions discovered whilst still endoscopically treatable, and also to reduce the number of lesions that progress to advanced gastric cancer. Figure 1. Proportion of gastric neoplasms treated with ESD and AGCs according to the interval between endoscopic examinations. Asterisk denotes a significant difference compared with the reference (O 60 months). Sa1471 Hematochezia Predicts Large Polyps in Patients 40 to 49 Years Old Karen Saks*, Brintha K. Enestvedt, Jennifer L. Holub, David A. Lieberman Internal Medicine, Oregon Health and Science University, Portland, OR; Gastroenterology, Oregon Health and Science University, Portland, OR Introduction: Indications for colonoscopy in patients 40-49 years old are highly variable with conflicting literature on its utility in this cohort given historically low yield of significant findings. We hypothesize hematochezia will be associated with a higher prevalence of large polyps/tumors in patients age 40-49 undergoing colonoscopy compared to the reference groups. Our aim was to determine the prevalence of large polyps in 40-49 year old patients and compare outcomes in different indication groups. Methods: Using the Clinical Outcomes Research Initiative (CORI) database, all patients age 40-49 who underwent a colonoscopy between 2000 and 2012 were identified. The following indications for colonoscopy were studied: hematochezia with and without anemia/iron deficiency (IDA), anemia/IDA (without hematochezia), weight loss, and non-specific GI symptoms which included bloating, abdominal pain, change in bowel habits, constipation, and diarrhea. We determined the prevwww.giejournal.org Vol alence of polyps O9 mm or suspected malignant tumor (here forth, large polyps), which has been demonstrated to be a robust surrogate for advanced neoplasia. This prevalence was compared with two reference groups: 1) 40-49 year olds who underwent colonoscopy for non-specific GI symptoms (defined above) and 2) 50-54 year olds who underwent routine screening colonoscopy. The results were stratified by gender and indication for colonoscopy. Multivariate logistic regression analyses (controlling for gender, race, and indication) were performed to determine odds ratios for our groups of interest with each reference group. Results: During the study period, a total of 65,892 colonoscopies with the indications of interest were performed in patients age 40-49. The prevalence of large polyps by indication and gender is summarized in Table 1. The prevalence of large polyps in those with hematochezia without anemia/IDA (7.2% males, 5.2% females) is higher than the prevalence in average-risk 50-54 year olds (6.2% M, 4.1% F) and in 40-49 year olds with non-specific GI symptoms (3.9% M, 2.7% F). The results of multivariate analyses in our cohort are presented in Table 2. Patients age 40-49 with hematochezia were approximately 2 times more likely to have a large polyp compared to age matched patients with non-specific GI symptoms and approximately 1.3 times more likely to have a large polyp compared to average-risk 50-54 year old patients. Conclusion: Compared to patients age 40 to 49 with non-specific GI symptoms and patients age 50 to 54 who are average risk for colorectal cancer, the prevalence of large polyps is higher in men and women age 40 to 49 with hematochezia. These data suggest that strong consideration be given to performing lower endoscopy in 40 to 49 year old men and women with hematochezia. Table 1: Prevalence of Large Polyps/Tumors Procedure Indication ume 79, No. 5S Men with Polyp(s) O9mm/ Suspected Malignant Tumor : 2014 GASTROINTEST Women with Polyp(s) O9mm/ Suspected Malignant Tumor Average-Risk Screening 50-54 yo 3231/52462 (6.2%) 1938/47251 (4.1%) Hematochezia with Anemia/IDA* 30/388 (7.7%) 22/416 (5.3%) Hematochezia without Anemia/ IDA* 1190/16458 (7.2%) 737/13440 (5.5%) Anemia/IDA* without Hematochezia 133/2193 (6.1%) 186/5072 (3.7%) Weight Loss 26/535 (4.9%) 26/662 (3.9%) Non-Specific GI Symptoms+ 351/9073 (3.9%) 481/17649 (2.7%) +Non-Specific GI SymptomsZbloating, abdominal pain, change in bowel habits, constipation, and diarrhea *IDAZIron deficiency anemia Table 2: Results of Multivariate Analysis in Patients Age 40-49 Characteristic Reference: 40-49 y/o with Non-specific GI Symptoms IN Reference: 50-54 y/o Average-Risk Screening Odds Ratio 95% Confidence Interval Odds Ratio AL ENDOS 95% Confidence Interval Indication Group Non-specific GI symptoms+ 1.0 (reference) 0.63 0.59-0.68 Hematochezia with Anemia/IDA* 2.10 1.57-2.81 1.33 1.01-1.77 Hematochezia without Anemia/IDA* 1.99 1.83-2.16 1.26 1.19-1.33 Anemia/IDA* without Hematochezia 1.49 1.30-1.70 0.94 0.84-1.06 Weight Loss 1.35 1.02-1.80 0.86 0.65-1.14 Average Risk Screening 50-54 y/o 1.58 1.46-1.70 1.0 (reference) Sex Female 1.0 (reference) 1.0 (reference) Male 1.48 1.41-1.55 1.48 1.41-1.55 Race Non-White Non-Hispanic 1.0 (reference) 1.0 (reference) White Non-Hispanic 1.14 1.08 1.20 1.14 1.08 1.20 +Non-Specific GI SymptomsZbloating, abdominal pain, change in bowel habits, constipation, and diarrhea *IDAZIron deficiency anemia