An Usual Suspect: Gastro-Colic Fistula Presenting as Diarrhea and Weight Loss

Abstract

Purpose: It has been suggested African Americans(AA) begin screening for colorectal cancer screening at age 45 by the ASGE's and the American College of Gastroenterology. Previous studies have shown that blacks have greater mortality risk from colorectal cancer, younger age at presentation, a higher proportion of cancers presenting before age 50, lower screening rates than whites and more advanced cancer at diagnosis. We evaluated the adenoma detection rate by ethnicity in the age group younger then age 50. Methods: In a retrospective study evaluating 60,802 colonoscopies (84.44% Caucasians, 7.17% AA, 5.55% Hispanics, 0.82% Asians) performed between Jan 1, 2001 Oct 30, 2010 with (84.44% Caucasians, 7.17% AA, 5.55% Hispanics, 0.82% Asians) we analyzed the adenoma detection rate in sub-groups distributed according to ethnicity and age in 5 year increments. We queried the Oracle database powering our EMR system (Cerner Powerchart) for all the colonoscopy reports available for patient demographics as well as adenoma detection and colon cancer. Results: In the 45-50 years old group 5063 (8.32%) colonoscopies were performed (83.3% Caucasians, 6.67 % AA, 6.39% Hispanics, 1.22% Asians). The overall adenoma detection rate (ADR) was 12.87%, for Caucasians 12.94%, for AA 11.53%, for Hispanics 13.58% and for Asians 12.9%. In the group over 50 years ADR was for Caucasians 21.62%, for AA 20.96%, for Hispanics 19.21% and for Asians 21.67% (Table 1). Chi square analysis of ADR in the 45-50 years age group revealed no statistical significant difference between Caucasians AA (p=0.5109), Caucasians Hispanics (p=0.8073) or AA Hispanics (p= 0.4815). Also no statistical difference (p=0.901) was seen in regards to the incidence of colon cancer between Caucasians (26 cases) and AA (2 cases). Conclusion: The findings in our population having a colonoscopy performed at our hospital for any indication suggest the recommendations earlier screening starting at 45 years for African Americans or Hispanics could be extended also to Caucasians. Future prospective studies are needed to validate these findings.