Su1247 Postcolonoscopy Colorectal Cancer (PCCRC) in a Population of a Closed System of Health Care Provision

Abstract

BACKGROUND: Previous studies have demonstrated that patients post cholecystectomy have had no definitive association with colorectal adenomatous polyps. It is thought that chronic inflammation from bile acids may lead to increase development of colorectal polyps. Post cholecystectomy chronic diarrhea is likely from bile acid exposure. Additionally chronic constipation is thought to be an risk factor for colorectal cancer. The purpose of this study is to investigate for an increased risk for colorectal adenomas in post cholecystectomy patients and to look for the association of polyps with chronic diarrhea in these patients. METHODS: We performed a retrospective chart review of the patients who underwent cholecystectomy between 01/200112/2012 who also had a colonoscopy following surgery. Patients without a personal history of IBD, colorectal polyps and/or family history of colorectal cancer were included in the study. Patients were further divided into two groups, those with and without chronic diarrhea. Polyps were further classified based on histology and location. RESULTS: A total of 395 patients were included in the study (63% female, with a mean age of 50 y). The average number of years between the cholecystectomy and a colonoscopy was 2.6 years. An increased risk for colorectal polyps 151(38%) (95% confidence interval (CI)-0.33-0.43) was found among these patients when compared to an average risk in general population aged 50 y (20%). A total of 28% patients in the study were found to have proximal colon polyps (0.28, 95% CI 0.21 to 0.36) and no significant difference was found when compared to the average risk population (13-37%). In contrast an increased risk of polyps in distal colon 48% (0.48, 95% CI: 0.40 to 0.56) was found when compared to the average risk population (25-40%). Twenty five percent of patients had polyps in both proximal and distal colon 37/151 (0.25; 95% CI 0.18 to 0.32), statistics were not compared to the general population. Hyper plastic polyps were found in 37% (0.37, 95%CI: 0.29 to 0.45) patients, which were not found to be at increased risk when compared to average risk (20-40%). Adenomas, 55% (0.55, 95% CI: 0.46 to 0.63), were found to be at increased risk when compared to average risk (25-30%). Additionally an increased risk was found for serrated polyps, 9% (0.09, 95% CI 0.05 to 0.15), when compared to average risk (1-7%). In patients with chronic diarrhea the proportion of polyps was 0.26 compared to 0.43 in those without chronic diarrhea. (Odds ratio=0.47, 95% CI 0.29-0.75, P=0.002), revealing a negative association of polyps with chronic diarrhea in this set of patients. CONCLUSIONS: Cholecystectomy was found to increase the risk for distal colorectal adenomas/polyps. Chronic diarrhea was found to be negatively associated with colorectal polyps in this set of patients.