Colonic Neoplasia Research Articles

Characterization of Mucosal Dysbiosis of Early Colonic Neoplasia.

Aberrant crypt foci (ACF) are the earliest morphologically identifiable lesions in the colon that can be detected by high-definition chromoendoscopy with contrast dye spray. Although frequently associated with synchronous adenomas, their role in colorectal tumor development, particularly in the proximal colon, is still not clear. The goal of this study was to evaluate the profile of colon-adherent bacteria associated with proximal ACF and to investigate their relationship to the presence and subtype of synchronous polyps present throughout the colon. Forty-five subjects undergoing a screening or surveillance colonoscopy were included in this retrospective study. Bacterial cells adherent to the epithelia of ACF and normal mucosal biopsies were visualized by in situ hybridization within confocal tissue sections. ACF showed significantly greater heterogeneity in their bacterial microbiome profiles compared with normal mucosa. One of the bacterial community structures we characterized was strongly correlated with the presence of synchronous polyps. Finally, using DNA mass spectrometry to evaluate a panel of colorectal cancer hotspot mutations present in the ACF, we found that three APC gene mutations were positively associated with the presence of Instestinibacter sp., whereas KRAS mutations were positively correlated with Ruminococcus gnavus. This result indicates a potential relationship between specific colon-associated bacterial species and somatically acquired CRC-related mutations. Overall, our findings suggest that perturbations to the normal adherent mucosal flora may constitute a risk factor for early neoplasia, demonstrating the potential impact of mucosal dysbiosis on the tissue microenvironment and behavior of ACF that may facilitate their progression towards more advanced forms of neoplasia.

Clinical and financial impacts of introducing an endoscopic mucosal resection service for treatment of patients with large colonic polyps into a regional tertiary hospital.

Background and study aims Endoscopic mucosal resection (EMR) of large sessile or laterally spreading colonic lesions is a safe alternative to surgery. We assessed reductions in Surgical Resection (SR) rates and associated clinical and financial benefits following the introduction of an EMR service to a large regional center. Patients and methods Ongoing prospective intention-to-treat analysis of EMR was undertaken from time of service inception in 2009 to 2017. Retrospective data for SR of large sessile/laterally spreading colonic lesions were collected for the period 4 years before commencement of the EMR service (2005 – 2008) and 9 years after its introduction (2009 – 2017). Results From 2005 to 2008, 32 surgical procedures were performed for non-malignant colonic neoplasia (50 % male, median age 68 years, median Length of Stay (LoS) 10 days). Following the introduction of the EMR service, there was a 56 % reduction in the number of patients referred for surgery (32 surgical procedures, 47 % male, median age 70 years, median LoS 8.5 days). During this period, EMR was successfully performed in 183 patients with 216 lesions resected (60 % male, median age 68 years, median LoS 1 day). Compared to the SR group, the EMR cohort had a lower peri-procedural complication rate (7.7 % vs 54.7 %, P < 0.0001), and shorter average LoS (1 vs 9 days, P < 0.0001). A cost saving of AUD $ 19 543.5 was seen per lesion removed with EMR compared to SR. Conclusions The introduction of a dedicated EMR service into a large regional center as an alternative to SR can lead to a substantial decrease in unnecessary surgery with subsequent clinical and financial benefits.

Does Colon Polyp Surveillance Improve Patient Outcomes?

Colon polyp surveillance now accounts for 25% of all colonoscopies performed. The evidence that colonoscopy surveillance reduces colorectal cancer (CRC) incidence or mortality is weak. The biology of the baseline lesions and quality of the baseline exam are two primary factors contributing to post-colonoscopy CRC. Prior recommendations for surveillance were based largely on the likelihood that patients with adenomas would develop advanced adenomas, a surrogate for CRC. There is now evidence that baseline colonoscopy findings are strongly associated with the risk of incidence or death from CRC. This evidence provides a basis for updated evidence-based recommendations for surveillance. In addition, there is also growing evidence that the quality of the baseline exam is an important predictor of the likelihood of developing post-colonoscopy CRC.

Cancer screening in adults with down syndrome, a proposal.

The specific distribution of cancers in Down syndrome (DS) calls into question the validity of screening policies for cancer surveillance as implemented for the general population. We performed a literature review of cancer screening opportunities for adults with DS, taking account of the tumor profile in this specific population. In DS, solid tumors in adults are at most half as common as in the overall group of persons with intellectual disabilities, who have a frequency similar to that of the general population. In women with DS, breast cancer is rare, the frequency of colorectal cancer is poorly described, and cervical cancer is rarely reported, although sometimes observed at an advanced stage. Young men have an increased risk of testicular cancer. We propose that adults with DS should participate in colon cancer screening. For women with DS, breast cancer screening is not recommended, but annual clinical monitoring should be conducted, with the option to perform ultrasound or MRI examination in suspect cases. For cervical cancer, screening could be proposed to women who are sexually active beginning at age 25 years. Annual surveillance for testicular cancer via palpation by a health professional is preferable from ages 15 to 45. In case of additional genetic predisposition in a person with DS, a surveillance similar to other family members is recommended. The specific tumor profile in DS warrants an adapted screening program for breast, colon, cervical and testicular neoplasia.

2850 Fecal Immunochemical Test in Asymptomatic People

INTRODUCTION: Occult blood is strategy for colorectal cancer screening. The aim of this study is to analyze the value of quantitative monoclonal antibodies against human Hemoglobin for colonoscopy screening. METHODS: One hundred asymptomatic adult patients, aged over 40 up to 77, with no risky group, have had one sample of stool specimens collected for qualitative immunochromatography with monoclonal antibodies against human hemoglobin, following several days later by complete colonoscopy. Chi-square was used to compare proportional data whereas Student t test to compare means. P &lt; 0.05 was considered significant. This was a prospective stufy, All patients signed the informed consent The author has no finantial disclosures. RESULTS: A total of 100 patients being 36 men aged 67 ± 7 and women 64 aged 65,5 ± 8 P &gt; 0.05, distributed by age in patients with colon neoplasia and positve occult blood in stools, 67 ± 6 N1 = 20, with negative occult blood in stools with neoplasia aged 68 ± 6 N2 = 11, with positive occult blood in stools without neoplasia 65,5 ± 9 N3 = 21 and negative occult blood in stools withou neoplasia 64,5 ± 8 N4 = 48 P &gt; 0.05.Thirty-one (31%) of the patients had diagnosisof colon neoplasia, being 20 (64%) with positive occult blood in stools and 11 (35%) negative, P &lt; 0.01. In the Group with positive occult blood in stools, two patients had diagnosis of adenocarcinoma, the others were adenomas. In the Group of negative occult blood in stools all were adenomas. We had 69 patients without neoplasia, of whom 21 (30.5%) had positive occult blood in stools and 48 (69%) negative, P &lt; 0.01. In this Group without neoplasia, 12 (17%) had an abnormal colonoscopy, 5 (41.5%) with positive occult blood in stools and 7 (58%) negative P &gt; 0.05. Abnormalities without neoplasia in patients with or withou occult blood in stools were angiodysplasia in ascending colon, shallow ulcer in ileocecal valve or ascending colon in NSAID user and uncomplicated diverticular disease. CONCLUSION: The age of the Group studied was similar, Adenocarcinoma only occurred in patients with positive blood in stools. Adenoma was present in positive and negative, although significantly more frequent in the positive ones. For bether conclusion, we need a greater number of asymptomatic people to be studied. The ideal test would be one that diagnoses cancer for treatment and adenoma for endoscopic prevention.

120 Microscopic Colitis and Risk of Colon Adenomas: A Multicenter Retrospective Cohort Study

INTRODUCTION: Microscopic colitis (MC) is a common cause of chronic watery diarrhea. Cross-sectional studies have suggested that patients with MC have a lower incidence of colon polyps compared to those without MC. However, existing literature is limited by a lack of longitudinal follow-up and the use of average-risk patients, rather than those with chronic diarrhea as controls. We aimed to further explore the association between MC and colon adenomas. METHODS: This retrospective cohort study included patients that underwent colonoscopy at Mayo Clinic (Rochester, MN) or Columbia University Medical Center (New York, NY) between 7/1/2006 and 12/31/2016. Consecutive cases with MC were identified using pathology databases at each center. Controls had chronic diarrhea, underwent colonoscopy, and did not have MC on biopsy. Cases and controls were matched 1:2 by age (±3 years), sex, and date of index colonoscopy (±6 months). Data was collected on demographics, tobacco and alcohol use, personal and family history of colon neoplasia, and presence of adenomas at the index or follow-up colonoscopies. RESULTS: The study included 376 patients with MC and 752 non-MC patients with chronic diarrhea. The median (range) age of patients was 64 (21, 88) years and 72% were female. Duration of follow-up was not significantly different between the 2 groups (total person years: cases 577, controls 972; P = 0.99) and 51 subjects had a new adenoma on follow-up. There were no significant differences in age, sex, alcohol use, family history of colon neoplasia, and personal history of inflammatory bowel disease between cases and controls. Patients with MC were more likely to be current tobacco users (10% vs. 6%, P = 0.02) and less likely to have a history of prior colon neoplasia (9% vs. 17%, P &lt; 0.001). Patients with MC were significantly less likely to have colon adenomas at the time of their index colonoscopy (5% vs. 12%; odds ratio 0.36; 95% CI 0.21, 0.60; P &lt; 0.001) after adjusting for tobacco use and history of prior lesions. However, when followed over time, there was no significant association between MC and risk of colon adenomas (Figure 1, P = 0.45) after adjusting for tobacco use, history of prior lesions, and presence of adenoma at index colonoscopy. CONCLUSION: Patients with MC are less likely to have colon adenomas at their index colonoscopy compared to those with chronic diarrhea without MC. However, when followed longitudinally, there appears to be no significant association between MC and risk of colon adenomas.

Predicting Anastomotic Leak after Elective Colectomy: Utility of a Modified Frailty Index

Background Anastomotic leak is the most dreaded complication following colonic resection. While patient frailty is increasingly being recognized as a risk factor for surgical morbidity and mortality, the current colorectal body of literature has not assessed the relationship between frailty and anastomotic leak. Objective Evaluate the relationship between patient frailty and anastomotic leak as well as patient frailty and failure to rescue in patients who suffered an anastomotic leak. Design Retrospective cohort study. Setting American College of Surgeons National Surgical Quality Improvement Program Database from 2015-2017. Patients Patients with the diagnosis of colonic neoplasia undergoing an elective colectomy during the study time period. Main outcome measure Anastomotic leak, failure to rescue. Results 30,180 elective colectomies for neoplasia were identified. The leak rate was 2.9% (n=880). Compared to non-frail patient, frail patients were at increased odds of anastomotic leak for (frailty score =1: OR=1.34, 95% CI: 1.10-1.63; frailty score=2: OR=1.32, 95% CI: 1.04-1.68; frailty score=3: OR 2.41, 95% CI: 1.47-3.96). After an anastomotic leak, compared to non-frail patient, a greater proportion of frail patients experienced mortality (3.4% vs. 5.9%), septic shock (16.1% vs. 21.0%), myocardial infarction (1.1% vs. 2.9%), and pneumonia (6.8% vs 11.8%). Furthermore, the odds of mortality, septic shock, myocardial infarction, and pneumonia increased in frail patients with higher frailty scores. Limitations Potential misclassification bias from lack of a strict definition of anastomotic leak, retrospective design of the study. Conclusion Frail patients undergoing colectomy for colonic neoplasia are at increased risk of an anastomotic leak. Furthermore, once a leak occurs, they are more vulnerable to failure to rescue. See Video Abstract at http://links.lww.com/DCR/B784.

1481 Synchronous Esophageal and Colon Adenocarcinoma: A Case Report

INTRODUCTION: Synchronous carcinomas in the same patient were first elucidated in the early 1930s. Following this initial recognition, awareness of synchronous carcinomas coupled with advancements in medical technology have made diagnosis of two primary carcinomas from separate sites in the same time interval possible. We present a case of newly diagnosed synchronous primary esophageal and ascending colon adenocarcinomas in a patient presenting with lower gastrointestinal bleed. CASE DESCRIPTION/METHODS: A 74-year-old female with a history of abdominal aortic aneurysm repair on dual-antiplatelet therapy, chronic obstructive pulmonary disease (COPD) on continuous supplemental oxygen at four liters per minute, and tobacco abuse presented with complaints of bright red blood per rectum. Hemoglobin on presentation was 12.5 g/dL, down-trending to 9.0 g/dL the following day. Esophagogastroduodenoscopy (EGD) revealed a nodule in esophageal mucosa, a submucosal lesion in the esophageal body, 30 centimeters from the incisors, and a small hiatal hernia with initial pathology showing high grade dysplasia in Barrett mucosa. There was no active bleeding site and hemoglobin was stable. Patient was discharged with plan for repeat EGD for evaluation of dysplastic Barrett mucosa and complete work up for anemia. Repeat EGD with endoscopic mucosal resection showed Barrett esophagus and a distal esophageal mass at 30 cm. Colonoscopy showed an ascending colon mass. Histopathology with ancillary immunohistochemistry revealed synchronous primary esophageal adenocarcinoma and a second primary ascending colonic adenocarcinoma. The patient was then staged as esophageal adenocarcinoma T2N0 by endoscopic ultrasound with recommendations for esophageal resection and T2N0 colon adenocarcinoma with recommendations for hemicolectomy. Given comorbidities, she was deemed not a candidate for esophagectomy, however successfully underwent elective right hemicolectomy. DISCUSSION: Common synchronous carcinomas within the gastrointestinal tract include colon and appendiceal malignancies, followed by small bowel, gastric, and esophageal carcinomas. Colonic neoplasias (up to 20%) are the most common synchronous cancers in patients with primary gastric cancer; the incidence of esophageal and synchronous colon cancers is unknown, however, highlighting this case's uniqueness. Upon discovering multiple primary malignancies, accurate staging along with immunohistochemical analysis is key to distinguish each primary cancer and determine appropriate therapy.

280 Patients With Non-Colorectal Cancers May Be at Elevated Risk of Colorectal Neoplasia

INTRODUCTION: Screening for colonic neoplasia has decreased the incidence of colorectal cancer in the United States in the past two decades. Whether personal history of noncolorectal cancer is a risk factor for colonic neoplasia has not been studied. We assessed the risk of colorectal neoplasia in noncolorectal cancer survivors. METHODS: We conducted a retrospective study of patients who had undergone colonoscopy for any indication between 2009 and 2018. Colonic adenoma detection rate and multivariate logistic regression were conducted to assess for the primary outcomes of the study. RESULTS: The study included 9408 cancer patients and 3295 control patients. Colonic adenomas were detected in 4503 cancer patients (48%) and 950 cancer-free patients (29%). Histologic examination of these adenomas revealed tubulovillous features in 620 patients (5%) and villous in 153 (1%). High-grade dysplasia was detected in 1611 patients (13%). Invasive colorectal adenocarcinoma was detected in 455 patients (12%); this rate was highest in patients with multiple myeloma (14%) (Table 1). Multivariate analysis revealed that a personal history of noncolorectal cancer was associated with increased risk of adenoma (Odd ratio, 2.04; 95% CI, 1.84–2.26; P &lt; 0.001). The adenoma detection rate was 30% in patients younger than 40 years (n = 1211), 32% in patients between 41 and 50 years (n = 812), 47% in patients between 51 and 60 years (n = 2892), and 55% in patients older than 60 years (n = 4493) (Figure 1). CONCLUSION: The adenoma detection rate in patients with a personal history of noncolorectal cancer is higher than the reported rate of the general population and our control group.

Three-Dimensional Nanoscale Nuclear Architecture Mapping of Rectal Biopsies Detects Colorectal Neoplasia in Patients with Inflammatory Bowel Disease.

Patients with inflammatory bowel disease (IBD) colitis are at an increased risk of developing colorectal cancer and are currently recommended to undergo extensive annual or biennial colonoscopy, a costly and invasive procedure. Most surveillance colonoscopies are negative with no existing objective measures for assessing their risk of developing cancer. We have recently developed a less invasive, cost-effective and objective method to assess cancer risk by detecting the presence of colonic neoplasia via 3-dimensional (3D) nanoscale nuclear architecture mapping (nanoNAM) of normal-appearing rectal biopsies. To establish its translational relevance, we prospectively recruited 103 patients with IBD colitis undergoing surveillance colonoscopy and measured submicroscopic alterations in aberrant intrinsic nuclear architecture of epithelial cells from normal-appearing rectal biopsies with nanoNAM. The results were correlated with the histologic diagnoses from all random biopsies obtained during initial and follow-up colonoscopy within 3 years. Using nanoNAM-based structural characterization as input features into a soft margin-based ν-SVM risk classifier, we show that nanoNAM detects colonic neoplasia with AUC of 0.87 ± 0.04, sensitivity of 0.81 ± 0.09, and specificity of 0.82 ± 0.07 in the independent validation set. In addition, projecting nanoNAM features onto a 2-sphere reveals patients with low-risk and high-risk IBD colitis existing on separate hemispheres. Finally, we show that this ability to assess cancer risk translates to clinically-relevant estimation of individual-patient likelihood of being truly at risk. We demonstrate the potential of nanoNAM to identify patients with IBD at higher risk of developing cancer from normal-appearing rectum tissue, which may aid clinicians in patients with personalized IBD colitis surveillance.

Prediction of advanced colonic neoplasm in symptomatic patients: a scoring system to prioritize colonoscopy (COLONOFIT study)

BackgroundFast-track colonoscopy to detect patients with colorectal cancer based on high-risk symptoms is associated with low sensitivity and specificity. The aim was to derive a predictive score of advanced colonic neoplasia in symptomatic patients in fast-track programs.MethodsAll patients referred for fast-track colonoscopy were evaluated. Faecal immunological haemoglobin test (3 samples; positive> 4 μg Hb/g), and a survey to register clinical variables of interest were performed. Colorectal cancer and advanced adenoma were considered as advanced colonic neoplasia. A sample size of 600 and 500 individuals were calculated for each phase 1 and phase 2 of the study, respectively (Phase 1, derivation and Phase 2, validation cohort). A Bayesian logistic regression analysis was used to derive a predictive score.Results1495 patients were included. Age (OR, 21), maximum faecal-Hb value (OR, 2.3), and number of positive samples (OR, 28) presented the highest ORs predictive of advanced colonic neoplasia. The additional significant predictive variables adjusted for age and faecal-Hb variables in Phase 1 were previous colonoscopy (last 5 years) and smoking (no, ex/active). With these variables a predictive score of advanced colonic neoplasia was derived. Applied to Phase 2, patients with a Score > 20 had an advanced colonic neoplasia probability of 66% (colorectal cancer, 32%), while those with a Score ≤ 10, a probability of 10% (colorectal cancer, 1%). Prioritizing patients with Score > 10, 49.4% of patients would be referred for fast-track colonoscopy, diagnosing 98.3% of colorectal cancers and 77% of advanced adenomas.ConclusionsA scoring system was derived and validated to prioritize fast-track colonoscopies according to risk, which was efficient, simple, and robust.

Assessment of the Value of Comorbidity Indices for Risk Adjustment in Colorectal Surgery Patients.

Comorbidity indices (CIs) are widely used in retrospective studies. We investigated the value of commonly used CIs in risk adjustment for postoperative complications after colorectal surgery. Patients undergoing colectomy without stoma for colonic neoplasia at a single institution from 2009 to 2014 were included. Four CIs were calculated or obtained for each patient, using administrative data: Charlson-Deyo (CCI-D), Charlson-Romano (CCI-R), Elixhauser Comorbidity Score, and American Society of Anesthesiologists classification. Outcomes of interest in the 90-day postoperative period were any surgical complication, surgical site infection (SSI), Clavien-Dindo (CD) grade 3 or higher complication, anastomotic leak or abscess, and nonroutine discharge. Base models were created for each outcome based on significant bivariate associations. Logistic regression models were constructed for each outcome using base models alone, and each index as an additional covariate. Models were also compared using the DeLong and Clarke-Pearson method for receiver operating characteristic (ROC) curves, with the CCI-D as the reference. Overall, 1813 patients were included. Postoperative complications were reported in 756 (42%) patients. Only 9% of patients had a CD grade 3 or higher complication, and 22.8% of patients developed an SSI. Multivariable modeling showed equivalent performance of the base model and the base model augmented by the CIs for all outcomes. The ROC curves for the four indices were also similar. The inclusion of CIs added little to the base models, and all CIs performed similarly well. Our study suggests that CIs do not adequately risk-adjust for complications after colorectal surgery.

Exploratory Analysis of Plasma Neurotensin as a Novel Biomarker for Early Detection of Colorectal Polyp and Cancer

Earlier detection of colorectal cancer (CRC) results in improved survival. Existing non-invasive biomarkers have suboptimal accuracy. Neurotensin (NTS) is involved in CRC carcinogenesis. This study evaluated the diagnostic potential of plasma NTS for colorectal polyps and cancers. Participants were selected based on national CRC referral guidelines. All subjects underwent colonoscopy. Average plasma concentrations were compared across different diagnostic groups. Predictors for detecting colorectal neoplasia were identified. Receiver operator characteristic (ROC) curve analysis assessed the diagnostic accuracy of NTS. An independent biobank was used as validation group. Of 165 participants, 46 had polyps or CRC. Significantly higher plasma NTS was found in the colonic neoplasia group (603.6 pg/ml vs. 407.2 pg/ml, p < 0.01). Risk factors for colonic polyps or cancers included Loge (plasma NTS concentration) (OR, 2.73; 95% CI, 1.33–5.59, p < 0.01), loge (Age) (OR, 15.49; 95% CI, 2.67–89.66, p < 0.01) and cigarette smoking (OR, 3.49; 95% CI, 1.31–9.26, p = 0.01). Plasma NTS had an optimal sensitivity of 60.4% and specificity of 71.6% for the diagnosis of colorectal polyps and cancers. Similar diagnostic accuracy was obtained in the validation group. Plasma NTS has the potential to be a non-invasive biomarker for colorectal neoplasia. It appears to be more accurate than existing blood markers and is unique in being able to detect precancerous polyps.

Bariatric surgery is independently associated with a decrease in the development of colorectal lesions

BackgroundObesity is a risk factor for colorectal cancer and possibly the formation of precancerous, colorectal polyps . Bariatric surgery is very effective for long-term weight loss; however, it is not known whether bariatric surgery decreases the risk of subsequent colonic neoplasia. We hypothesized that bariatric surgery would decrease the risk of developing colorectal lesions (new cancer and precancerous polyps). MethodsWe reviewed all patients (n = 3,676) who underwent bariatric surgery (gastric bypass, sleeve gastrectomy, or gastric banding) at the University of Virginia (Charlottesville, VA) 1985–2015. Obese, nonoperative patients (n = 46,873) from an institutional data repository were included as controls. Cases and controls were propensity score matched 1:1 by demographics, comorbidities, body mass index, and socioeconomic factors. The matched cohort was compared by univariate analysis and conditional logistic regression. ResultsA total of 4,462 patients (2,231 per group) with a median follow-up of 7.8 years were well-matched with no statistically significant baseline differences in initial body mass index (48 vs 49 kg/m2), sex, and age in addition to other comorbidities (all P > .05). The operative cohort had more weight loss (55.5% vs –1.4% decrease in excess body mass index, P < .0001). The operative cohort developed fewer colorectal lesions (2.4% vs 4.8%, P < .0001). We observed no differences in polyp characteristics or staging for patients who developed cancer (all P > .05). After risk adjustment, bariatric surgery was independently associated with a decrease in new colorectal lesions (OR 0.62, 95% CI 0.42–0.91, P = .016). ConclusionBariatric surgery was associated with lesser, risk-adjusted incidence of new colorectal lesions in this large population of propensity matched patients undergoing bariatric surgery compared with a control group not undergoing bariatric surgery. These results suggest the benefits of bariatric surgery may extend beyond weight loss and mitigation of comorbidities.

Nancy Index Scores of Chronic Inflammatory Bowel Disease Activity Associate With Development of Colorectal Neoplasia

The degree of histologic and endoscopic disease activity has been associated with an increased risk of colorectal neoplasia (CRN) in patients with inflammatory bowel diseases (IBDs), but no histologic scoring systems have been validated for determining risk of CRN. We investigated the association between histologic and endoscopic disease activity and risk of first CRN in patients with IBD who had negative findings from a surveillance colonoscopy. We performed a retrospective analysis of consecutive patients who underwent at least 2 colonoscopies at Saint Antoine Hospital in France from January 1, 1996, through March 1, 2015, and whose first procedure was a surveillance colonoscopy. Histologic IBD activity was assessed by the Nancy histologic index. Patients were followed up for a mean 5.7 ± 3.3 years. Logistic regression and generalized estimating equations were used to identify clinical, endoscopic, and histologic factors associated with detection of neoplasia in the inflamed colon mucosa. Among 398 patients who underwent 1277 colonoscopies, we identified 45 patients with CRN. Factors associated with CRN were primary sclerosing cholangitis (odds ratio [OR], 2.65; 95% CI, 1.06-6.61; P= .04), age (OR per 1-year increase, 1.04; 95% CI, 1.01-1.07; P= .003), and mean Nancy histologic index during follow-up evaluation (per 1-unit increase, OR, 1.69; 95% CI, 1.29-2.21; P < .001). After adjustment for established factors, chronic disease activity defined as detection of ulcerations at more than 50% of colonoscopies was not associated with an increased risk of CRN (OR, 1.24; 95% CI, 0.53-2.91; P= .62). In addition to established risk factors, we associated Nancy histologic index scores with development of CRN. Histologic findings based on the Nancy histologic index therefore should be included in determining the risk of colonic neoplasia in patients with IBD.

338 – Liver Transplantation for Primary Sclerosing Cholangitis in Inflammatory Bowel Disease Does Not Impact the Rate of Colonic Neoplasia

338 – Liver Transplantation for Primary Sclerosing Cholangitis in Inflammatory Bowel Disease Does Not Impact the Rate of Colonic Neoplasia

Tu1655 – The Long Term Impact of Roux-En-Y Gastric Bypass Surgery on Colorectal Cancer: A Fourfold Increase in Risk of Serrated Colonic Neoplasia

Tu1655 – The Long Term Impact of Roux-En-Y Gastric Bypass Surgery on Colorectal Cancer: A Fourfold Increase in Risk of Serrated Colonic Neoplasia

Sa1105 – Conditional Knockout of Cdc42/Rac Nucleotide Exchange Factor, ΒPix, Attenuates Colon Neoplasia Without Adversely Affecting Murine Growth, Fertility Or Longevity

Sa1105 – Conditional Knockout of Cdc42/Rac Nucleotide Exchange Factor, ΒPix, Attenuates Colon Neoplasia Without Adversely Affecting Murine Growth, Fertility Or Longevity

English

Colorectal cancer (CRC) has a high prevalence in both sexes. Although its incidence among the elderly is declining, some studies show an increased incidence in age group under 50 populations, an age group that is not included in the global screening protocols. However, screening the disease in a defined population at younger age groups is of paramount importance in reducing mortality rate. This is an ecological study that spans from 1990 to 2016 in Brazil aimed at knowing the incidence of this neoplasm in the Brazilian population below 50 years. Data recorded by the Global Burden of Disease (GBD) revealed that patients under 50 years of age were diagnosed with invasive CRC. The results showed significant association between CRC and age groups 15 to 49 years (p&lt;0.01) in both sexes while the association trend rose with increasing age. Also, there was a significant increase in hospitalizations for colorectal cancer in all age groups (14 to 49 years) in both sexes. Key words: Colon neoplasia, epidemiology. &nbsp

Utility of a standardized training program for endoscopic diagnosis of early gastrointestinal neoplasia.

Background and study aims Image enhanced endoscopy (IEE) allows endoscopists to improve recognition and characterization of gastrointestinal neoplasia. The Asian Novel Bio-Imaging and Intervention Group (ANBIG) conducted a standardized training program in endoscopic diagnosis and treatment of early gastrointestinal cancers in Asia. We embarked on a study to investigate the effect of this module on endoscopic diagnosis of early gastrointestinal neoplasia. Methods This prospectively collected database was from workshops conducted on training for endoscopic diagnosis of early gastrointestinal neoplasia. All workshops were conducted in a standardized format, which included a pretest, a learning phase consisting of didactic lectures, case discussion, and live demonstration followed by a post-test to assess knowledge gained. The pretest and post-training tests were standardized questions addressing four domains, including basic knowledge of imaging and diagnosis of esophageal, gastric, and colonic neoplasia. Results From November 2013 to November 2016, 41 ANBIG workshops were conducted in 13 countries. A total of 1863 delegates and 40 faculty participated in these workshops. Of the delegates, 627 completed both tests. There was a significant improvement after training in all domains of the tests. There was a trend in general lack of knowledge across all domains for delegates from “low” healthcare cost countries before training. All delegates demonstrated significant improvement in knowledge of all domains after the workshop irrespective of whether they were from “high” or “low” healthcare cost per capita countries. Conclusion A standardized teaching program on IEE improved the diagnostic ability and quality of endoscopists in recognizing early gastrointestinal neoplasia in Asia.