Family History Of Colon Polyps Research Articles

S525 Early Colonoscopy Due to a Family History of Colon Polyps Identifies Increased Prevalence of Advanced Adenomas but Not Colon Cancer

S525 Early Colonoscopy Due to a Family History of Colon Polyps Identifies Increased Prevalence of Advanced Adenomas but Not Colon Cancer

Familial Adenomatous Polyposis within the Pediatric Hereditary Polyposis Registry

Background/Objective: 
 Familial Adenomatous Polyposis (FAP) is a condition characterized by values exceeding hundreds of colorectal adenomatous polyps. FAP has a prevalence of 1 in 8,300 people, demonstrating an autosomal dominant inheritance pattern. This condition follows a pathogenic variation of the Adenomatous Polyposis Coli (APC) gene, located on chromosome 5q21-22. These mutations are heavily correlated with the incidence of colorectal carcinoma, requiring prophylactic colectomy. The management and treatment of FAP requires routine surveillance to reduce gastrointestinal polyp burden. The objective for this study is to characterize the current patient population at Riley with polyposis syndromes and assess clinical surveillance in patients diagnosed with FAP. 
 Methods: 
 Historical data from 2020-2022 GI clinical visits were reviewed using the diagnostic codes Family history of colonic polyps, Benign neoplasm of colon unspecified, and Other phakomatoses not elsewhere classified. These criteria identified 93 patients of which 64 patients were diagnosed with a hereditary polyposis syndrome for inclusion within the registry. Of the 64 patients, 42 had a diagnosis of FAP. Clinical data reviewed included the patient’s age of diagnosis, completion of genetic testing and follow-up, surgical treatment, routine endoscopic surveillance, and modes of imaging. 
 Results: 
 Results indicated a median age of diagnosis of 10 years, lower than previously reported national averages of 13.5-17 years. Evaluation of routine follow-up indicated a rate of endoscopy at 0.822 scopes per year and demonstrated that abdominal CT scans as well as abdominal X-rays were the most common supplemental modes of imaging. 
 Conclusion/ Future Directions: 
 The data from this registry will help direct care of patients with FAP, ensuring they receive treatment in accordance with national guidelines for routine surveillance and prophylactic colectomy. Moving forward, the intention is to expand the registry's date range to incorporate more patients and elaborate further on endoscopic findings for the specific subtypes of FAP.

Family History of Colon Polyps Might Confer Excess Risk for Colorectal Cancer

A person with a family history of colorectal cancer (CRC) has excess risk for developing CRC and might merit more-intensive CRC screening. Does a

S3090 Colon Polyps in Cirrhotics: A Community Practice Experience

INTRODUCTION: Colorectal cancer (CRC) is the third most common cancer and leading cause of cancer death in men and women in the US. Premalignant polyps are common, occurring in 25-50% of all people of screening age, and about 5% of the population will develop CRC in their lifetime. In patients with cirrhosis, colonoscopy is performed routinely for CRC screening and for a variety of indications related to GI complications of cirrhosis as well as to assess eligibility for liver transplantation. We aimed to analyze our experience with colonoscopy findings in patients with liver cirrhosis in a community setting. Methods: All colonoscopies performed in patients with a diagnosis of liver cirrhosis at South Denver Gastroenterology, P.C. in between 2006 and 2019 were retrospectively analyzed. First, a Poisson Generalized Linear Mixed Model (GLMM) was used to analyze the effect size of gender and age. Then, the effect of multiple colonoscopies was evaluated in a sub-cohort by including it as an effect in the model along with sex and age. Last, a binary GLMM was used to detect associations linking colonoscopy indications to findings. Results: Our study included 351 outpatient elective colonoscopies performed in patients with liver cirrhosis for the following indications: colon cancer screening (n = 147), prior personal or family history of colon polyps or cancer (n = 109), diarrhea (n = 31), constipation (n = 8), anemia (n = 31), GI bleed (n = 28) and abdominal pain (n = 12). Mean age of the group was 62.3 +/- 9.4 years; 158 patients were female and 193 were male. Adenomatous polyps were found in 159 procedures (49.07%, Table 1) and were 4 times more likely to be in the right colon (76.73%) than the left colon (18.87%). Left-sided adenoma occurrence was 61% lower in women than men (P = 0.042). Neither indication for the procedure (P = 0.08) nor advancing age (P = 0.94) impacted ADR. In patients with multiple colonoscopies (n = 49), there was no increase in number of adenomas found in subsequent exams (P = 0.11) on the contrary, significantly less right sided adenomatous polyps were detected (P = 0.025). Conclusion: Adenoma detection rate in elective colonoscopies performed in a community setting in patients with liver cirrhosis is greater than that in the general population, regardless of indication, gender and age. Our ADR (49%) was greater than that usually reported in the literature (23-30%). Male patients were more likely to have left sided colon adenomas than females, the impact of cirrhosis etiology and hormonal milieu is raised.Figure 1.: Frequency and number of adenomas found in colonoscopies in patients with liver cirrhosis.Table 1.: Frequency of adenomas found in patients with liver cirrhosis according to age

Tu1167 FELLOW INVOLVEMENT IN SCREENING COLONOSCOPY DOES NOT IMPROVE QUALITY OF THE PROCEDURE WHEN ATTENDING ADR IS HIGH

Colonoscopy is the preferred method for colorectal cancer (CRC) screening with established benefit in reducing CRC incidence and mortality. Interval CRC is inversely proportional to the quality of the procedure. Given the importance of providing a quality colonoscopy, there is great interest in studying the effects of different procedural factors on the Adenoma and Polyp Detection Rates (ADR and PDR). Colonoscopy quality differs widely among providers and is affected by several factors. It remains unclear whether participation of gastroenterology fellows affects the quality of the procedure, and whether the skill level at different stages of training contributes to any change in quality of the colonoscopy. We aim to investigate whether GI fellows at different stages of training have different ADR and PDR compared to screening colonoscopies performed by attendings without fellows. We performed a retrospective review of a random sample of patients who underwent a screening colonoscopy at our institution between January 2017 and June 2019. Patients with personal or family history of colon polyps or cancer, and those undergoing a diagnostic colonoscopy were excluded. Descriptive statistics were reported as proportions or means. Categorical variables were compared using Chi-Square test of association with a 95% confidence interval. A total of 895 colonoscopies met the inclusion criteria and were included in the analysis. The mean age of the study patients was 59 years, 51.1% were females. GI fellows were involved in 40.5% of the procedures. The ADR and PDR in the fellow participation group were similar to those in the attending group (42% vs 44%, p= 0.59; 54% vs 51%, p= 0.58, respectively). No significant differences were noted in ADR or PDR when first year fellows were excluded or when third year fellows were compared to the attending group. The ADR and PDR increased numerically with advancement in fellowship without reaching statistical significance (ADR = 38%, 40%, 49 % for first, second, and third year fellows respectively). In our sample, fellow involvement did not impact the ADR or PDR. However, the overall ADR was 43% which is significantly higher than the minimum acceptable ADR of 30% for men and 20% for women. While attendings and fellows have been appropriately vigilant in their mucosal inspection, the high ADR in both groups left little room for improvement. While data regarding fellow involvement on colonoscopy outcomes remains controversial, one could characterize it as “quality-neutral” as it is associated with at least equal ADR. Therefore, colonoscopy performed by a supervised fellow should not be disregarded for delivering low-quality services for patients. In addition, attending’s expertise appears to inversely correlate with the added potential benefit of fellow involvement.

1640 Case Report: Diffuse Large B-Cell Lymphoma Presenting as Multiple Lymphomatous Polyposis

INTRODUCTION: Diffuse Large B Cell Lymphoma (DLBCL) is the most common type of Non-Hodgkin’s Lymphoma (NHL) in the U.S. accounting for one third of all newly diagnosed NHL’s. The gastrointestinal (GI) tract is the most common site of extra nodal involvement with mucosa-associated lymphoid tissue (MALT) lymphoma and DLBCL accounting for 70-95% of all GI lymphomas. Multiple lymphomatous polyposis (MLP) is a rare presentation of GI lymphoma characterized by diffuse proliferation of lymphocytes that present as multiple polypoid tumors involving long segments of the GI tract. MLP classically presents in mantle cell lymphoma, but can also present, although less frequently, in MALT and follicular lymphomas. We present a unique case of a patient that presented initially with lower GI bleed and was subsequently found to have extensive polypoid lesions in the entire colon. Histological evaluation revealed DLBCL, a rare etiology of MLP. CASE DESCRIPTION/METHODS: A 93-year-old woman with chronic thrombocytopenia suspicious for low-grade MDS and history of a large tubulovillous adenoma without high-grade dysplasia or cancer for which she had undergone a right hemicolectomy, presented to the emergency department with intermittent rectal bleeding, severe anemia, fatigue, decreased appetite, and a 17 pound weight loss over the past 2 months. Her hemoglobin level on admission was 6.5 g/dL (baseline Hgb 11 g/dL) and all other cell counts were otherwise normal. Her last colonoscopy ten years ago was normal and she was given the choice to continue or forego colon screening given her age. She had no family history of colon polyps or colorectal cancer. Colonoscopy revealed approximately 50-100 sesile polypoid lesions from the ileocolonic anastomosis to the distal rectum, ranging in size from 2-40 mm. The larger lesions were predominantly located in the proximal colon and were ulcerated and friable. Multiple biopsies were obtained and pathology results revealed diffuse large B-Cell lymphoma. Further studies revealed stage IV DLBCL without bone marrow involvement and she was started on mini R-CHOP chemotherapy. DISCUSSION: Although DLBCL is a rare cause of MLP, it should be included in the differential diagnosis in patients with multiple polypoid lesions throughout the colon that do not fit the typical phenotype for hereditary polyposis syndromes. Lymphomas associated with MLP include MALT and follicular lymphomas; however, DLBCL and other less common lymphomas should be considered when evaluating patients with this entity.

Qualitative Investigation of FIT Colorectal Cancer Screening Uptake in an Uninsured Urban Minority Population

Introduction: Colorectal cancer (CRC) is the 2nd leading cause of cancer death in the USA. Screening and prevention of CRC with stool testing and colonoscopy is cost effective and greatly reduces the risk for CRC and death. Fecal immunochemical testing (FIT) has been shown to be more accurate than guaiac testing for CRC and advanced adenoma detection. Our post-intervention analysis aims to identify barriers to FIT in patients who were provided with free FIT as part of a comprehensive cancer screening program. Methods: Validated standardized surveys were mailed to 100 patients who ‘returned' FIT kits and 100 patients who ‘refused to return' FIT kits (Image 1). Patients received a $5 gift card if they completed the questionnaire. Postage-paid return envelopes were included. Patients had two months to return the completed questionnaires. Results: A total of 17 ‘returned' questionnaires and 8 of ‘refused' questionnaires were completed. Of the 17 ‘returned' questionnaires, 13 were female and 4 were male. 8 of the ‘returned' respondents were African American, while 3 were Caucasian, 4 were Hispanic and 2 were Asian. Further demographics are shown in Image 2.2763_A Figure 1. Mailed Surveys2763_B Figure 2. Study DemographicsConclusion: We report low response rates for both questionnaires. This suggests that identifying barriers to FIT/colonoscopy screening remains challenging in an uninsured urban minority population. African American females with income <$10,000 were the predominant respondents from the ‘returned' cohort, which may indicate better screening uptake among this subpopulation. Six (35%) of ‘returned' respondents reported previous FIT, while none of the ‘refused' cohort had previous FIT. This may represent an unfamiliarity factor among ‘refused' respondents. Among the ‘returned' respondents, some of the identified reasons that influenced use of the FIT kit included lack of insurance, family history of colon polyps, interest in preventative screening and physician recommendation during an encounter for screening mammogram. ‘Difficult instructions' was listed as a reason for not using the FIT kit by 12.5% of the ‘refused' respondents while others from this cohort reported not receiving the kit or not having time to perform the testing. Although eliciting information regarding barriers to FIT kit use remains challenging, more study into this area is warranted to increase CRC screening rates.

Proctitis: Whatʼs the Bottom Line?

This is a case of a 45 y/o male with a history of GERD, hemorrhoids and syphilis who presented for 2 months of anal pain, hematochezia and constipation, ultimately diagnosed with proctitis. This is being presented given the unique etiology of proctitis, rare in clinical practice. While findings including endoscopy present similarly to IBD, this diagnosis requires a high degree of suspicion and supportive history. He previously failed fiber, probiotics and stool softeners. He admitted to anal intercourse but denied a family history of colon polyps or cancer. Exam was notable for hemorrhoids, perianal condylomata and anal fissure. Labs were normal and no imaging was performed. Given his symptoms, he underwent diagnostic colonoscopy with good prep to the terminal. Nodular, friable and ulcerated mucosa encompassing 50% of the luminal circumference, extending 10cm proximal to the anus was seen. Pending biopsy results, he was started on empiric rectal mesalamine. Pathology revealed acute cryptitis, chronic inflammation, granulation tissue and reactive changes. Findings were not classic of IBD given inflammation was not circumferential and was more mass like than ulcerative. Biopsy was negative for CMV, HSV 1/2, spirochetes and dysplasia or malignancy using pancytokeratin and p16 immunostains. Serum HIV and syphilis were negative. Given atypical appearance, rectal swab was obtained, revealing C. trachomatis and N. gonorrhoeae RNA. These findings and clinical suspicion led to a diagnosis of Lymphogranuloma venereum proctitis with a 21 days of treatment with doxycycline. This is an uncommon form of infectious proctitis caused by the L1-L3 serovars of Chlamydia trachomatis. Risk factors include men who have sex with men, previous STIs and ulcerative disease. Lymphatic spread occurs after the bacterium passes the epithelial barrier, usually via unprotected anal intercourse. Hemorrhagic proctitis results with anorectal pain, bleeding, tenesmus and constipation. Endoscopically there is rectal inflammation, often mistaken for IBD. Clues include supportive history and failure to improve with IBD therapy. Diagnostic techniques include nucleic acid amplification testing to detect C. trachomatis and the specific serotype. Alternatives include culture and serology. First line therapy is doxycycline with erythromycin preferred in pregnant or breastfeeding women. As with other STIs, sexual partners should be informed, screened and treated if similarly affected.1526_A Figure 1. Endoscopic view from colonoscopy. Evidence of nodular appearing, mass like ulceration of the rectal mucosa, encompassing approximately fifty percent of the luminal circumference.1526_B Figure 2. Histologic slide from rectal biopsy, detailing acute cryptitis with associated reactive changes.1526_C Figure 3. Magnification of histologic slide from rectal biopsy, showing further evidence of chronic inflammation alongside acute cryptitis.

Serum DCLK1 as a Biomarker for Adenoma and Colorectal Neoplasia Detection in Patients Referred for Colonoscopy

Introduction: Doublecortin-like kinase 1 (DCLK1), a putative tumor stem cell marker has been shown to be highly expressed in the stromal and epithelial compartments in colon and pancreatic cancer as well as Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). The aim of this study was to investigate whether DCLK1 can be used as an early diagnostic marker for adenoma detection and colorectal neoplasia in serum. Methods: Consecutive patients referred to the Oklahoma City VA Medical Center for colonoscopy were prospectively enrolled into the study from January to May 2017. Five milliliters (mls) of blood was drawn from each patient prior to colonoscopy. During colonoscopy biopsies were obtained and/or polypectomy was performed if indicated and sent to pathology. Tissue samples were stratified into groups after microscopic analysis; normal (n=13), hyperplastic polyp (HP; n=25), tubular adenoma (TA; n=80), tubular adenoma with high-grade dysplasia and colorectal adenocarcinoma (HGD and CRC; n=4). DCLK1 expression in serum was determined by ELISA and correlated with histopathology findings. Results: The study population consisted of 122 patients with mean age of 63.4 years; 94.3% were male. Majority (79.4%) were Caucasian. Increased expression of DCLK1 was found in the serum of patients in the HGD/CRC group compared to the other groups (normal, HP and TA; P=0.006). Increased expression of DCLK1 was also found in the serum of patients with diabetes (P=0.01). After controlling for diabetes, the difference in serum DCLK1 levels among the 4 histologic groups remained (p =0.0002). There was no association between serum DCLK1 expression and age, gender, ethnicity, BMI, tobacco use, alcohol use, personal or family history of colon polyps and/or CRC, polyp size, total polyp burden, or history of other GI cancers (all P>0.05), suggesting that DCLK1 expression in serum is independent of established risk factors for colon polyps and CRC. Conclusion: DCLK 1 may represent a novel molecular marker for detection of adenoma and CRC in serum. However, our results need to be interpreted with caution given the small number of patients in the HGD/CRC group. Enrollment of more patients in the normal and HGD/CRC groups will provide more robust results.Table: Table. Serum DCLK1 Concentration (ELISA) ng/mlFigure: Serum DCLK1 expression level by histology group.

Knowledge, Attitude, and Practice of Screening For Colon Cancer and Surveillance Colonoscopy for Patients With Predisposing Family History of Colon Cancer Among Primary Care Physicians and Gastroenterologists

Introduction: Colorectal cancer (CRC) remains one of the most commonly diagnosed cancers annually within the United States and is the second leading cause of cancer deaths in both men and women. Previous reports have shown that patients with a strong family history of colon polyps and CRC are at much higher risk of developing CRC. The American College of Gastroenterology (ACG) and American Society of Gastrointestinal Endoscopy (ASGE), have developed consensus guidelines on screening and surveillance of patients with family history predisposing to development of CRC. Despite the availability of these guidelines, there continues to be disparity in physician practice with compliance of guidelines, thus leading to delayed detection of this disease. Our study aims to characterize the knowledge, attitudes, and practice patterns in regards to screening and surveillance of CRC in patients with predisposing family history, amongst primary care physicians and gastroenterologists. Methods: A brief survey was distributed to gastroenterologists, internal medicine physicians, and family medicine physicians from all levels of training (residents, fellows, faculty). The survey included seven questions regarding screening and surveillance colonoscopies in patients at high risk for CRC based on significant family history [Figure 1]. Results of the survey from each group of physicians was compared to the standard guidelines to evaluate the knowledge of, and variations in practice patterns.Figure: Percentage of physicians amongst subspecialties with accurate knowledge of screening and surveillance colonoscopy guidelines.Results: We sent the survey to 258 physicians at our center. A total of 112 physicians completed the survey (16 gastroenterologists, 82 internists, and 16 family medicine physicians). Detailed results of the survey are summarized in Figure 2. Overall, gastroenterologists performed slightly better than their counterparts. The best response was 75% from GI doctors, where our expectation was close to 100%. The mean percentage of correct answer was 59%. Conclusion: Our study suggests that despite appropriate guidelines, the knowledge regarding screening and surveillance protocols for patients with a strong family history of colon cancer remains low at 58%. Our next steps include internal medicine, family medicine and gastroenterology house staff and faculty education and increased the correct response to 80%, so these high-risk patients can be identified and their screening and surveillance colonoscopy can be scheduled in a timely manner.Table: Table. Questionnaire of Appropriate Guidelines For Screening and Surveillance Colonoscopy at High Risk for Colorectal Cancer Based on Family History

Macrophage inhibitory cytokine-1/growth differentiation factor-15 as a predictor of colonic neoplasia.

Serum macrophage inhibitory cytokine-1 (MIC-1/GDF15) concentration has been associated with colonic adenomas and carcinoma. To determine whether circulating MIC-1/GDF15 serum concentrations are higher in the presence of adenomas and whether the level decreases after excision. Patients were recruited prospectively from a single centre and stratified into five groups: no polyps (NP); hyperplastic polyps (HP); sessile serrated ademona (SSA); adenomas (AP); and colorectal carcinoma (CRC). Blood samples were collected immediately before and 4 weeks after colonoscopy. MIC-1/GDF15 serum levels were quantified using ELISA. Participants (n=301) were stratified as: NP; n=116 (52%), HP; n=37 (12%), SSA; n=19 (7%), AP; n=68 (23%); and CRC; n=3 (1%). Patients were excluded from the study due to nondiagnostic pathology (n=9, 3%) and exclusion criteria (n=20, 6%). In the 272 remaining subjects (M=149; F=123), age (P=.005), history of colonic polyps (P=.003) and family history of colonic polyps (P=.002) were associated with presence of adenomas. Baseline median MIC-1/GDF15 serum levels increased significantly from NP 609 (460-797) pg/mL, HP 582 (466-852) pg/mL, SSA 561 (446-837) pg/mL to AP 723 (602-1122) pg/mL and CRC 1107 (897-1107) pg/mL; (P<.001). In the pre- and postpolypectomy paired adenoma samples median MIC-1/GDF15 reduced significantly from 722 (603-1164) pg/mL to 685 (561-944) pg/mL (P=.002). A ROC analysis for serum MIC-1/GDF15 to identify adenomatous polyps indicated an area under the curve of 0.71. Our data suggest that serum MIC-1/GDF15 has the diagnostic characteristics to increase the detection of colonic neoplasia and improve screening.

Clinical Predictors of Colonic Sessile Serrated Adenomas Include Obesity, Smoking, and Cancers Outside of GI System

Introduction: Sessile serrated adenomas (SSAs) are precursors to colorectal cancer (CRC). Here we aimed to identify factors which may predict an increased likelihood of the presence of SSAs during colonoscopy. Methods: We collected retrospective data for all patients diagnosed with SSAs in our institution during year 2014 to include patient history, clinical characteristics, and factors related to colonoscopy. Results: SSAs were found in 2.1% (119 patients) of all colonoscopies. Average age at the time of SSA detection was 59 years; 53% cases were in females; 7% had family history of colonic polyps and 11% of colon cancer. The majority (77%) of patients with SSA were overweight/ obese (BMI>25), with BMI 29.68±6.78 (average±SD). A minority of patients with SSAs took aspirin (24%), NSAIDs (12%) or statins (23%); 21% of them had cardiovascular co-morbidity, 17% had diabetes and 32% had known cancers outside of gastrointestinal system. Majority (53%) of patients with SSA were tobacco smokers. The colonoscope withdrawal time was 21±11 minutes and 60% cases had bowel prep good or better. The SSAs were located in the right colon in 43%; 13% SSAs were found in both right and left colon. One third (29%) SSA cases were performed with participation of fellow in training. Conclusion: We conclude that obesity, smoking, and presence of cancers outside of gastrointestinal system are features that that may lead to a higher suspicion for SSAs. Intake of agents known to reduce incidence of colorectal neoplasia, such as of ASA or NSAIDS, is infrequent among newly diagnosed SSA cases. Unlike previous reports of predominant prevalence of SSAs in the right colon and in female, we report that SSAs are equally present in males and distributed with equal frequency throughout GI tract. Finally, case performance with fellow, which are usually associated with prolonged examination, did not predict increased detection of SSAs. Describing clinical features of SSAs which may increase the suspicion for these higher risk polyps can be validated in prospective studies.

Genetic counseling and cascade genetic testing in Lynch syndrome.

Lynch syndrome is the most common cause of inherited colorectal and endometrial cancers. Individuals with Lynch syndrome have a 10-80% lifetime risk for colorectal cancer and a 15-60% lifetime risk for endometrial cancer. Both cancers are preventable through chemoprevention, intensive cancer surveillance, and risk-reducing surgery options. Efforts to identify as many individuals with Lynch syndrome as possible will prevent cancers and save lives. This includes the traditional cancer genetic counseling model whereby individuals with and without cancer are evaluated for a possible Lynch syndrome diagnosis based on their personal and family history of colon polyps and cancers. It also includes universal tumor screening for Lynch syndrome whereby all individuals with colorectal or endometrial cancer are screened for tumor features of Lynch syndrome at the time of diagnosis. Those with tumors suspicious for Lynch syndrome are referred for cancer genetic counseling regardless of their family history of cancer. This two approaches must be maximized to attain high patient reach. Finally, and perhaps most importantly, cascade testing among the at-risk relatives of those diagnosed with Lynch syndrome is critically important to maximize the diagnosis of individuals with Lynch syndrome. In fact, the cost-effectiveness of universal tumor screening for Lynch syndrome relies entirely on counseling and testing as many at-risk individuals as possible since young unaffected individuals stand to benefit the most from an early diagnosis of Lynch syndrome. This approach must be optimized to achieve high family reach. It will take a concerted effort from patients, clinicians and public health officials to improve current approaches to the diagnosis of Lynch syndrome and the prevention and treatment of Lynch syndrome-associated cancer but these lessons can be applied to other conditions as the ultimate example of personalized medicine.

Health Promotion Behavior in Colorectal Cancer Patients and General Adults

Purpose: This study was designed to identify the differences of individual disease related characteristics, behavior-specific cognitions and affect, health promoting behavior between colorectal cancer patients and the general public. Methods: Seventy newly diagnosed colorectal cancer patients and 72 healthy adults from the general population were recruited and asked to complete a questionnaire on their disease related characteristics, behavior specific cognitions and affect, health promoting behavior from April to September 2011. Independent two sample t-test analysis was used to compare the two groups. Results: There were significant differences in family history of colon polyps or colorectal cancer, history of colon polyps lifetime tobacco usage, amount of daily smoking, frequencies of alcohol consumption over a year, constipation, interval of bowel movements, perceived benefits, perceived barriers, self-efficacy, self-esteem, perceived health status, health locus of control, and health promotion behaviors between the two groups. Conclusion: This study suggests that nursing professionals need to consider family history of colon polyp or colorectal cancer, history of colon polyps, tobacco usage, alcohol consumption, constipation and frequency of bowel movements in developing a colorectal cancer prevention program. Strategies to increase health promotion behavior and behavior-specific cognitions and affect factors including perceived benefit, perceived barriers, self-efficacy, self-esteem, perceived health status, health locus of control should be included in colorectal cancer prevention programs.

Low Rate of Large Polyps (>9 mm) Within 10 Years After an Adequate Baseline Colonoscopy With No Polyps

Guidelines recommend a 10-year interval between screening colonoscopies with negative results for average-risk individuals. However, many patients are examined at shorter intervals. We investigated outcomes of individuals with no polyps who had repeat colonoscopy in <10 years. Data were collected using the National Endoscopic Database, from 69 gastroenterology centers, on 264,184 asymptomatic subjects who underwent screening colonoscopies from 2000 through 2006, were found to have no polyps, and received another colonoscopy examination within <10 years. No polyps were found in 147,375 patients during a baseline colonoscopy; 17,525 patients (11.9%) had a follow-up colonoscopy within <10 years, including 1806 (10.3%) who received the follow-up colonoscopy within <1 year. The most common reason for repeating the examination within 1 year was that the first was compromised by inadequate bowel preparation or incomplete examination. Of these patients, 6.5% (95% confidence interval: 5.3-7.6) had large polyp(s) >9 mm-a proportion similar to the prevalence in the average-risk screening population. Reasons that examinations were repeated within 1-5 years included average-risk screening (15.7%), family history of colon polyps or cancer (30.1%), bleeding (31.2%), gastrointestinal symptoms (11.8%), or a positive result from a fecal blood test (5.5%). If the baseline examination was adequate, the incidence of large polyps within 1-5 years after baseline colonoscopy was 3.1%(95% confidence interval: 2.7-3.5) and within years 5-10 years was 3.7% (95% confidence interval: 3.3-4.1). Repeat colonoscopies within 10 years are of little benefit to patients who had adequate examinations and were found to have no polyps. Repeat colonoscopies are beneficial to patients when the baseline examination was compromised.

Squamous papilloma of the anal canal

Squamous papillomas of the gastrointestinal tract are usually limited to the oral cavity [1], oropharynx [1], and the esophagus [2,3]; squamous papilloma of the anal canal is a rare entity. We report a case of a squamous papilloma of the anal canal, initially suspected to be a fibroepithelial anal polyp. An asymptomatic 60-year-old man underwent screening colonoscopy because of a strong family history of colonic polyps. Total colonoscopy was normal but retroflexion of the scope in the rectum revealed a 5-mm, sessile, nodular anal polyp (● Fig.1), which felt rigid when taking biopsy samples with cold forceps. Initially, a fibroepithelial anal polypwas suspected, but histopathological examination revealed fragments of mature squamous epithelium, which were of normal thickness and parakeratinized, without underlying fibrovascular stroma. Focally the lesion was slightly hypertrophic. The basal layer showed undulation, and regular polarity and cellular organization. Low mitotic activity was present in the basal and parabasal layers only, while the upper layers exhibited degenerative changes. A few binuclear cells were found. Some of the detached, smaller fragments resembled tips of fingerlike papillary projections. There were no signs of dysplasia or malignancy (● Fig.2). Human papilloma virus (HPV) was not detected in the biopsy samples using p16 immunostaining as a surrogate marker (● Fig.3). An index colonoscopy done at age 50 was completely normal. As the patient was asymptomatic, no endoscopic or surgical resection was carried out. Squamous papilloma of the anal canal is a rare benign epithelial neoplasm that can be mistakenly suspected to be a fibroepithelial anal polyp.The tumor is characterized by papillomatous processes and covered by keratinized squamous epithelium [4]. HPV negative lesions are also commonly regarded as ‘burned-out’ condylomas [4]. It is important for colonoscopists to keep such lesions inmindwhen considering the differential diagnosis of an anal polyp. Fig.2 a Fragments of papillomatous squamous epithelium with focal papillary projections (magnification ×5). b Squamous cells showing degenerative changes (cytoplasmic vacuolization); a binuclear cell is seen (arrow; magnification ×10).

Poor patient knowledge regarding family history of colon polyps: implications for the feasibility of stratified screening recommendations

In 2008, the American College of Gastroenterology (ACG) modified its colorectal screening guidelines regarding patients with family histories of colorectal polyps, specifically highlighting the importance of obtaining detailed history that includes the number, type, and size of adenomas found in a patient's relative. This information is then used to guide screening recommendations for these patients. To assess the proportion of patients undergoing screening colonscopy for a family history of polyps who have knowledge of their family members' colonoscopy findings. Retrospective, single-center cohort pilot study. Tertiary care medical center. Patients who presented for screening colonoscopy between 2008 and 2010 with an indication of family history of polyps. Obtain detailed history regarding patient's family history of polyps, including which family member, age of family member at diagnosis, size, type and number of polyps found. Knowledge of family history. Seventy-three patients were included in the study. Their knowledge of their family histories of polyps showed the following: 23.2% (17/73; 95% CI, 14%-35%) did not know which family member had polyps, 42.5% (31/73; 95% CI, 31%-55%) did not know the age at diagnosis, 71.2% (52/73; 95% CI, 59%-81%) did not know the polyp type, 90.4% (66/73; 95% CI, 81%-96%) did not know the number of polyps found, and 97.3% (71/73; 95% CI, 90%-100%) did not know the polyp size. Retrospective study at a single tertiary referral center. Patients' knowledge regarding the details of their family histories of polyp data appears often unknown or incomplete. Thus, at present, it may not appear feasible or practical to incorporate this level of information in colon cancer screening guidelines.

Prevalence of Adenomas in 40-49 Year Olds With a Family History of Colon Polyps

Prevalence of Adenomas in 40-49 Year Olds With a Family History of Colon Polyps

Rethinking Screening Recommendations for Patients with a Family History of Colon Polyps

Rethinking Screening Recommendations for Patients with a Family History of Colon Polyps

Results from a Colonoscopy Based Screening Program for the Uninsured: A Pilot Study from South Carolina

Purpose: The purpose of our study was to screen through colonoscopy a racially diverse, uninsured population in rural South Carolina (SC). Methods: 150 patients aged 42 to 64 years were recruited from four free medical clinics and one federally qualified health center in 2008 and 2009. Participants were residents of rural counties in South Carolina. We targeted four counties because of the high incidence of colorectal cancer within this region. The screening program was made possible by a grant from the Blue-Cross BlueShield Foundation of South Carolina and a partnership between the SC Gastroenterology Association and the Center for Colon Cancer Research at USC. Each patient underwent a screening colonoscopy by a board certified gastroenterologist, at no charge to the patient. Participants completed a brief questionnaire addressing basic demographic characteristics, medical history and family history of polyps and/or colorectal cancer. To assess the association between colorectal lesions and personal risk factors, we estimated risk ratios and 95% confidence intervals for one or more adenomas using generalized linear regression analyses using a logarithmic linkage and a Poisson distribution adjusted for age and gender. Results: The average age of subjects was 55.2 years (SD 4.9), 30% were male, and 54% were African American (AA). The majority of our participants were unemployed (70%) and almost all were uninsured (98.5%). 13% of patients reported a family history of colorectal polyps and 25% reported a family history of colorectal cancer. Overall, we observed that 36.5% of patients had at least one adenoma while 14% had at least one hyperplastic polyp. We found that women had a non-significantly lower risk of adenomas compared to men. AAs compared to Caucasians were more likely to have a greater number of adenomas (RR 1.23 (95% CI 0.79-1.93)), and more advanced histology neoplasms (RR 3.21 (0.92-11.19)) and were less likely to have hyperplastic polyps (RR 0.32 (95% CI 0.13-0.78). We observed that a family history of colorectal polyps (RR 1.84 (95% 1.05-3.20)) or colorectal cancer (RR 1.53 (95% CI 0.95-2.47) was associated with an increased risk of adenomas compared to those reporting no family history of colorectal neoplasia. Conclusion: Our study demonstrates that a colonoscopy based screening program in a racially diverse and medically underserved cohort is feasible. Furthermore, we found that AAs and those with a family history of colonic polyps or cancer are at increased risk of colorectal neoplasia. Our results point to the importance of the index colonoscopy and availability of follow-up surveillance exams to reduce the incidence of colorectal cancer in South Carolina and beyond.