Number Of Colonoscopies Research Articles

Metabolic syndrome and smoking may justify earlier colorectal cancer screening in men

Gender, smoking, and metabolic syndrome (MetS) are important risk factors of colorectal neoplasm. Whether presence of these factors may warrant earlier screening remains unclear. To compare age- and gender-specific risk of colorectal neoplasms in association with smoking and MetS under endoscopic or stool-based screening. Cross-sectional observational study. Screening center in a university hospital in Taiwan. A cohort of 10,884 average-risk individuals who received concurrent screening colonoscopy and fecal immunochemical testing (FIT). First, the prevalence of colorectal neoplasms and positive predictive value of FIT relative to age, gender, smoking, and MetS. Second, the number of colonoscopies needed to detect 1 advanced neoplasm with different strategies. Male smokers aged 40 to 49 years had a significantly higher prevalence of advanced neoplasms and positive predictive value of stool tests than nonsmoking counterparts. The prevalence of advanced neoplasms in concurrent MetS and smoking (6.2%) or smoking alone (3.8%) men aged 40 to 49 years was higher than that of average-risk women aged 50 to 59 years (2.1%) (P = .03 and .04, respectively). The number of colonoscopies needed to detect 1 advanced neoplasm in men aged 40 to 49 years with concurrent MetS and smoking, smoking, MetS, and women aged 50 to 59 years was, respectively, 14.6, 24.8, 39.8, and 47.4 in the colonoscopy scenario and 1.7, 4.6, 5.7, and 8.3 in the FIT scenario. Self-selective bias may exist for subjects voluntarily submitted to health check-ups. MetS and smoking significantly impact both the prevalence of colorectal neoplasms and the diagnostic yields of screening tests in men aged 40 to 49 years. Whether our findings justify earlier screening in this subgroup requires further study.

Rates of minor adverse events and health resource utilization postcolonoscopy.

Little is known about minor adverse events (MAEs) following outpatient colonoscopies and associated health care resource utilization. To estimate the rates of incident MAE at two, 14 and 30 days postcolonoscopy, and associated health care resource utilization. A secondary aim was to identify factors associated with cumulative 30-day MAE incidence. A longitudinal cohort study was conducted among individuals undergoing an outpatient colonoscopy at the Montreal General Hospital (Montreal, Quebec). Before colonoscopy, consecutive individuals were enrolled and interviewed to obtain data regarding age, sex, comorbidities, use of antiplatelets/anticoagulants and previous symptoms. Endoscopy reports were reviewed for intracolonoscopy procedures (biopsy, polypectomy). Telephone or Internet follow-up was used to obtain data regarding MAEs (abdominal pain, bloating, diarrhea, constipation, nausea, vomiting, blood in the stools, rectal or anal pain, headaches, other) and health resource use (visits to emergency department, primary care doctor, gastroenterologist; consults with nurse, pharmacist or telephone hotline). Rates of incident MAEs and health resources utilization were estimated using Bayesian hierarchical modelling to account for patient clustering within physician practices. Of the 705 individuals approached, 420 (59.6%) were enrolled. Incident MAE rates at the two-, 14- and 30-day follow-ups were 17.3% (95% credible interval [CrI] 8.1% to 30%), 10.5% (95% CrI 2.9% to 23.7%) and 3.2% (95% CrI 0.01% to 19.8%), respectively. The 30-day rate of health resources utilization was 1.7%, with 0.95% of participants seeking the services of a physician. No predictors of the cumulative 30-day incidence of MAEs were identified. The incidence of MAEs was highest in the 48 h following colonoscopy and uncommon after two weeks, supporting the Canadian Association of Gastroenterology's recommendation for assessment of late complications at 14 days. Predictors of new onset of MAEs were not identified, but wide CrIs did not rule out possible associations. Although <1% of participants reported consulting a physician for MAEs, this figure may represent a substantial number of visits given the increasing number of colonoscopies performed annually. Postcolonoscopy MAEs are common, occur mainly in the first two weeks postcolonoscopy and result in little use of health resources.

Response to Neis et al.

To the Editor: We thank Dr Neis et al. (1) for their letter about our study (2). We congratulate them on their work in reducing the number of colonoscopies requested with constipation as the sole indication in their center.

Perforations and haemorrhages after colonoscopy in 2010: A study based on comprehensive French health insurance data (SNIIRAM)

To estimate the perforation and haemorrhage rate after colonoscopy in the French population in 2010 and to identify risk factors for these complications. Study based on SNIIRAM and the PMSI databases. Patients treated for IBD or colorectal cancer were excluded. Two types of complications were investigated: perforation and haemorrhage. OR adjusted for patient (gender, age, chronic disease) and colonoscopy (polypectomy, emergency) characteristics were calculated by using a logistic regression model. The cohort was composed of 947,061 individuals. The estimated perforation rate was between 4.5 and 9.7 per 10,000 procedures and the estimated haemorrhage rate was between 9.9 and 11.0 per 10,000 procedures. The main risk factors associated with perforation and haemorrhage were the patient's age (over 80 years compared to under 40, OR=7.51 and 3.23), resection of polyps larger than 1 cm or more than 4 polyps (compared to no polypectomy, OR=2.72 and 5.12) and emergency colonoscopy (OR=4.63 and 5.99). Colonoscopy performed by a gastroenterologist performing less than 244 colonoscopies per year was associated with an increased risk of perforation (OR=2.29). Complication rates were higher in institutions performing less than 510 colonoscopies per year, but this was no longer the case after adjustment for emergency colonoscopies. This study, which includes nearly one million colonoscopies, suggests taking the gastroenterologist's number of colonoscopies into account to ensure optimal organization of the management of very elderly patients requiring colonoscopy.

Development and Validation of a Scoring System to Identify Individuals at High Risk for Advanced Colorectal Neoplasms Who Should Undergo Colonoscopy Screening

Screening the population for colorectal cancer (CRC) by colonoscopy could reduce the disease burden. However, targeted screening of individuals at high risk could increase its cost effectiveness. We developed a scoring system to identify individuals with at least 1 advanced adenoma, based on easy-to-collect risk factors among 7891 participants of the German screening colonoscopy program. The system was validated in an independent sample of 3519 participants. Multiple logistic regression was used to develop the algorithm, and the regression coefficient-based scores were used to determine individual risks. Relative risk and numbers of colonoscopies needed for detecting one or more advanced neoplasm(s) were calculated for quintiles of the risk score. The predictive ability of the scoring system was quantified by the area under the curve. We identified 9 risk factors (sex, age, first-degree relatives with a history of CRC, cigarette smoking, alcohol consumption, red meat consumption, ever regular use [at least 2 times/wk for at least 1 y] of nonsteroidal anti-inflammatory drugs, previous colonoscopy, and previous detection of polyps) that were associated significantly with risk of advanced neoplasms. The developed score was associated strongly with the presence of advanced neoplasms. In the validation sample, individuals in the highest quintile of scores had a relative risk for advanced neoplasm of 3.86 (95% confidence interval, 2.71-5.49), compared with individuals in the lowest quintile. The number needed to screen to detect 1 or more advanced neoplasm(s) varied from 20 to 5 between quintiles of the risk score. In the validation sample, the scoring system identified patients with CRC or any advanced neoplasm with area under the curve values of 0.68 and 0.66, respectively. We developed a scoring system, based on easy-to-collect risk factors, to identify individuals most likely to have advanced neoplasms. This system might be used to stratify individuals for CRC screening.

Dietary Supplement Use and Colorectal Adenoma Risk in Individuals with Lynch Syndrome: The GEOLynch Cohort Study

Background and AimsIndividuals with Lynch syndrome have a high lifetime risk of developing colorectal tumors. In this prospective cohort study of individuals with Lynch syndrome, we examined associations between use of dietary supplements and occurrence of colorectal adenomas.Materials and MethodsUsing data of 470 individuals with Lynch syndrome in a prospective cohort study, associations between dietary supplement use and colorectal adenoma risk were evaluated by calculating hazard ratios (HR) and 95% confidence intervals (CI) using cox regression models adjusted for age, sex, and number of colonoscopies during person time. Robust sandwich covariance estimation was used to account for dependency within families.ResultsOf the 470 mismatch repair gene mutation carriers, 122 (26.0%) developed a colorectal adenoma during an overall median person time of 39.1 months. 40% of the study population used a dietary supplement. Use of any dietary supplement was not statistically significantly associated with colorectal adenoma risk (HR = 1.18; 95%CI 0.80–1.73). Multivitamin supplement use (HR = 1.15; 95%CI 0.72–1.84), vitamin C supplement use (HR = 1.57; 95%CI 0.93–2.63), calcium supplement use (HR = 0.69; 95%CI 0.25–1.92), and supplements containing fish oil (HR = 1.60; 95%CI 0.79–3.23) were also not associated with occurrence of colorectal adenomas.ConclusionThis prospective cohort study does not show inverse associations between dietary supplement use and occurrence of colorectal adenomas among individuals with Lynch syndrome. Further research is warranted to determine whether or not dietary supplement use is associated to colorectal adenoma and colorectal cancer risk in MMR gene mutation carriers.

PTU-048 The Effect of the Colonoscope Magnetic Imaging Device (Scopeguide ®) on Implantable Cardiac Devices

IntroductionUse of the colonoscope magnetic imaging device (ScopeGuide®, Olympus) is currently contraindicated by the manufacturer for patients with implantable cardiac devices. This group of patients is increasing every year, as...

PTU-015 Trainee Endoscopic Procedures by Deanery and Year of Training in the United Kingdom: August 2011 to July 2012. are we doing Enough?

IntroductionThe burden of acute medicine on specialty trainee registrars (StR) is rising. Anecdotal evidence suggests that fewer endoscopic procedures are being performed by gastroenterology (GI) StR’s and that trainees although...

APC I1307K polymorphism as a predictive factor for colorectal neoplasia recurrence.

1526 Background: The use of surveillance colonoscopy to detect disease recurrence after initial colorectal neoplasia resection has increased significantly in the past decade. Currently, predictive factors at index colonoscopy include only histo-pathologic characteristics such as adenoma number, size, type and dysplasia. The goal of the current study is to identify additional factors (i.e., genetic markers) that increase the risk of subsequent lesions and may optimize the use of surveillance colonoscopies. Methods: A prospective analysis of 383 consecutive Israeli subjects with an initial neoplastic finding in screening colonoscopy. The participants were followed over a period of 10 years, and underwent up to five surveillance colonoscopies. Clinical data regarding potential risk factors for colorectal cancer as well as blood samples were collected. Genetic polymorphisms were detected using real-time PCR from DNA extracted from peripheral mononuclear cells. Results: The overall prevalence of recurrent Colorectal carcinoma and adenoma was 9.4% (36/383) and 69% (268/383) respectively, with a median of 4.8 years from index colonoscopy. In a univariate analysis, subjects with recurrent lesions had significantly higher number of adenomas at index colonoscopy (3.9 Vs 1.1, p=0.001), increased rate of high grade dysplasia (65.8% Vs 50%, p=0.018), and a non-significant trend for larger adenomas and villous histology. The APC I1307K gene variant was detected in 11.8% of subjects with recurrent lesions compared to 3.8% of subjects with normal follow-up colonoscopies (p=0.03). In a multivariate logistic regression (adjusted to age, sex, family history of CR neoplasia, time to recurrence and number of colonoscopies performed), the I1307K variant and the presence of dysplasia were the only significant predictive factors for recurrent neoplasia with an OR of 3.27 (1-11.02, p=0.05) and 1.72 (1.02-2.89, p=0.04) respectively. Conclusions: The APC I1307K gene variant is an important predictive factor for recurrent colorectal neoplasia after a positive index colonoscopy and should be considered as part of the criteria for high risk subjects among Israeli Jews.

Differences in Detection Rates of Adenomas and Serrated Polyps in Screening Versus Surveillance Colonoscopies, Based on the New Hampshire Colonoscopy Registry

The adenoma detection rate (ADR) is an important quality indicator originally developed forscreening colonoscopies. However, it is unclear whether the ADR should be calculated using data from screening and surveillance examinations. The recommended benchmark ADR for screening examinations is 20% (15% for women and 25% for men ≥50 y). There are few data available to compare ADRs from surveillance vs screening colonoscopies. We used a population-based registry to compare ADRs from screening vs surveillance colonoscopies. The serrated polyp detection rate (SDR), a potential new quality indicator, also was examined. By using data from the statewide New Hampshire Colonoscopy Registry, we excluded incomplete and diagnostic colonoscopies, and those performed in patients with inflammatory bowel disease, familial syndromes, or poor bowel preparation. We calculated the ADRand SDR (number of colonoscopies with at least 1 adenoma or serrated polyp detected, respectively, divided by the number of colonoscopies) from 9100 colonoscopies. The ADRand SDR were compared by colonoscopy indication (screening, surveillance), age at colonoscopy (50-64 y, ≥65 y), and sex. The ADR was significantly higher in surveillance colonoscopies (37%) than screening colonoscopies (25%; P < .001). This difference was observed for both sexes and age groups. There was a smaller difference in the SDR of screening (8%) vs surveillance colonoscopies (10%; P < .001). In a population-based study, we found that addition of data from surveillance colonoscopies increased the ADR but had a smaller effect on the SDR. These findings indicate that when calculating ADR as a quality measure, endoscopists should use screening, rather than surveillance colonoscopy, data.

The Yearly Prevalence of Findings in Endoscopy of the Lower Part of the Gastrointestinal Tract

Introduction. Endoscopy of the colon and rectum is increasingly used. Aim of the Study. All consecutive endoscopies of the colon and rectum were studied in order to assess the yearly prevalence of significant endoscopic diagnoses. Methods. All consecutive endoscopies of the colon and rectum were included. Endoscopies were done with endoscopes of Olympus. Significant endoscopic diagnoses were defined as colorectal cancer, polyps, diverticuli, large sessile polyps, and inflammatory bowel disease. Results. In 20 years a total of 24431 endoscopies were done. The yearly number of sigmoidoscopies was mean 96, range of 42–370. The number of colonoscopies was mean 1126, range of 643–1912. The number of colonoscopies significantly increased. The number of colonoscopies on request of an internist or gastroenterologist showed a slow but steady increase. Successful caecal intubation rose from 70% to 92% in 2011. Since 1996 there is a steep increase in the percentage of procedures with abnormalities. The number of cancer and polyps increased in twenty years. No great changes were seen in inflammatory bowel disease. Conclusion. Colonoscopy is a procedure with a high diagnostic yield. The number of patients with tumours rose in twenty years.

Risk for Coronary Heart Disease Increases Risk for Colorectal Neoplasm

Colorectal neoplasms and coronary artery disease have similar risk factors. Patients with established coronary artery disease have a high prevalence of colorectal neoplasms. However, little is known about the risk of colorectal neoplasms among individuals at risk for coronary artery disease. We performed a cross-sectional study of 3144 asymptomatic, average-risk individuals without history of coronary artery disease or other vascular disorders who received a screening colonoscopy examination from January to December 2010 at Konkuk University Medical Center in Seoul, Korea. Participants were classified as having low (<10%), intermediate (10%-20%), or high (≥20%) risk for developing coronary artery disease in the next 10 years, which was based on Framingham/Adult Treatment Panel III risk scores. The prevalence of colorectal neoplasms in subjects with low, intermediate, and high risk for coronary artery disease was 25.6% (635/2485), 46.6% (252/541), and 53.4% (63/118), respectively (P < .001); the prevalence of advanced colorectal neoplasms was 4.9% (122/2485), 9.2% (50/541), and 17.8% (21/118), respectively, for these subjects (P < .001). In multivariate analyses, the high-risk group had a significantly increased risk of advanced colorectal neoplasm (odds ratio, 3.31; 95% confidence interval [CI], 1.94-5.65), compared with the low-risk group. The numbers of colonoscopies needed to identify individuals with advanced colorectal neoplasms in intermediate-risk and high-risk groups were 10.8 (95% CI, 8.6-14.7) and 5.6 (95% CI, 7.6-11.9), respectively, which were significantly lower than for the low-risk group (20.4; 95% CI, 17.4-24.6). The prevalence and the risk of overall and advanced colorectal neoplasms increase with risk of coronary artery disease. Individuals with a 10-year risk of coronary artery disease ≥10% might benefit from colonoscopy screening, but further studies are needed to confirm and generalize these results.

Impact of Withdrawal Time on Adenoma Detection Rates: Analysis of Average Risk Screening Colonoscopy Examinations

Purpose: In average risk individuals undergoing screening colonoscopy, withdrawal time of at least six minutes or more in normal exams is considered as a quality indicator. However, data is conflicting on the correlation of withdrawal time and detection of adenomas. The aim of this study is to estimate the impact of withdrawal time on detection of adenomas and polyps. Methods: Retrospective analysis of average risk screening colonoscopies performed at a university hospital using the electronic reporting system was done. All patients who underwent a colonoscopy with the indication “screening-average risk” during the study period [2006-2011] were included. Surveillance procedures and patients with high risk family history were excluded since they are expected to have higher adenoma rate. We reviewed demographic details, procedural data and corresponding pathology reports. Polyp detection rate (PDR) is defined as the number of colonoscopies with at least one polyp removed/total number of procedures. Adenoma detection rate (ADR) is defined as the number of colonoscopies with removal of at least one pathologically confirmed adenoma/total number of procedures. Withdrawal time is defined as the time spent withdrawing from cecum to anus. Colonoscopies where polyps or malignancies were found were excluded, and only normal colonoscopies were included to calculate the mean withdrawal time for each endoscopist. Spearman Rank Correlation coefficient was calculated to estimate the degree of correlation between the withdrawal time and ADR/PDR. Results: A total of 2370 patients fulfilled the inclusion criteria. ADR, PDR, and mean withdrawal times for each of the participating endoscopists were calculated (see Table). The spearman rank correlation coefficient (S) for withdrawal time and ADR was 1.0 [P=0.016] confirming a perfect positive correlation between withdrawal time and ADR. The S coefficient for withdrawal time and PDR was 0.9, [P=0.083].Table: No Caption available.Conclusion: This study confirms that a longer duration of withdrawal time during screening colonoscopy improves adenoma detection rate.

Effect of Bowel Preparation Quality on Adenoma Detection Rate and Procedure Duration in Screening Colonoscopy

Purpose: Good quality bowel preparation is key for screening colonoscopy. Poor quality preparation can lead to missed lesions and prolong procedure time. Our aim was to study the impact of bowel preparation on adenoma detection rate and duration of the procedure. Methods: Retrospective analysis of average risk screening colonoscopies performed at a university hospital using the electronic reporting system was performed. All patients who underwent a colonoscopy with the indication “screening-average risk” during the study period [2006-2011] were included. Surveillance procedures and patients with high-risk family history were excluded since they are expected to have higher adenoma rate. We reviewed demographic details, procedural data and corresponding pathology reports. Polyp detection rate (PDR) is defined as the number of colonoscopies with at least one polyp removed/total number of procedures. Adenoma detection rate (ADR) is defined as the number of colonoscopies with removal of at least one pathologically confirmed adenoma/ total number of procedures. Bowel preparation was graded using Aronchick's scale (Table 1). Patients that had inadequate preparation were excluded from the analysis as they were rescheduled with re-preparation.Table: [1991] ResultsResults: Of 2,370 patients included in the study, 2291 (96.6%) had excellent/good/ fair bowel preparation, and 79 (3.3%) had poor bowel preparation. Cecal intubation rate and adenoma detection rate were similar in patients with excellent, good and fair preparation (see Table 2). But when poor preparation was compared with excellent preparation, ADR dropped to 18.9 % from 27.4% (p=0.06), and cecal intubation rate decreased to 70% from 93% (p=0.0001). Total duration of normal colonoscopies tended to increase progressively as the bowel preparation quality went down from excellent to poor.Table: Aronchick's scaleConclusion: Poor quality bowel preparation in screening colonoscopy leads to reduced cecal intubation rate, tends to increase procedure time, and reduce adenoma detection rate. Hence poor quality bowel preparation should be recognized early and lead to rescheduling the procedure rather than risking a poor quality screening colonoscopy.

Impact of Cecal Intubation Rate on Adenoma Detection Rate: Analysis of Average Risk Screening Colonoscopy Examinations

Purpose: Adenoma detection rate and cecal intubation rate are established independent quality indicators for a screening colonoscopy exam. However, data is conflicting regarding the effect of cecal intubation rate on the detection of adenomas. The aim of this study is to estimate the impact of cecal intubation rate on the detection of adenomas and polyps. Methods: Retrospective analysis of average risk screening colonoscopies performed at a university hospital using the electronic reporting system was done. All patients who underwent a colonoscopy with the indication “screening-average risk” during the study period [2006-2011] were included. Surveillance procedures and patients with high-risk family history were excluded since they are expected to have higher adenoma rate. We reviewed demographic details, procedural data and corresponding pathology reports. Polyp detection rate (PDR) is defined as the number of colonoscopies with at least one polyp removed/total number of procedures. Adenoma detection rate (ADR) is defined as the number of colonoscopies with removal of at least one pathologically confirmed adenoma/total number of procedures. Cecal intubation is defined as intubation beyond the ileo-cecal valve with complete examination of the cecum. Cecal intubation rate is defined as the proportion of exams where cecal intubation is completed. Incomplete exams due to poor or inadequate bowel preparation were excluded. Pearson Correlation coefficient was calculated to estimate the degree of correlation between the cecal intubation rate and ADR/PDR. Results: A total of 2,370 patients fulfilled the inclusion criteria. ADR, PDR and cecal intubation rates for each of the five participating endoscopists were calculated (see Table). The Pearson correlation coefficient (R) for cecal intubation rate and ADR was -0.4, but did not reach statistical significance [p= 0.50]. The R for cecal intubation rate and PDR was -0.2 and not statistically significant [p= 0.64].Table: No Caption available.Conclusion: Cecal intubation rate is not a good predictor of adenoma detection rate.

Gender Specific Prevalence of Adenomas, Advanced Adenomas, and Colorectal Cancer in Patients Undergoing Screening Colonoscopy

Purpose: Recent studies have shown that men may be at greater age specific risk of developing advanced colorectal neoplasia compared to women. However, current guidelines recommend screening colonoscopy at age 50 for both males and females. The aim of this study is to determine and compare the prevalence and numbers needed to screen (NNS) for adenomas, advanced adenomas and colorectal cancer in different age groups in men and women. Methods: Colonoscopy data was collected retrospectively from a university based hospital and included all average risk screening colonoscopies performed between 2006 and 2011. Demographic details, procedural data and corresponding pathology reports were recorded. Adenoma detection rate (ADR) is defined as: number of colonoscopies with removal of at least one pathologically confirmed adenoma/ total number of procedures. Advanced adenomas (AA) were defined as adenomas greater than 1 cm in size and/or with features of high grade dysplasia. Numbers needed to screen (NNS) is defined as the number of patients that need to undergo screening colonoscopy to detect one lesion. Statistical analyses of polyp and adenoma detection were performed using chi-square test and logistic regression. Results: Out of 2,388 patients included in the study, 1,217 (51%) were female. The age distribution was similar in men and women and the mean age was 59 years in both groups. Adenomas were found in 27%, AAs in 6.2%, and colorectal cancer (CRC) in 0.4% of all patients screened; NNS were 3.7, 16, and 263 respectively. Overall, men had a significantly higher prevalence of adenomas and AAs compared to women (32% vs. 23%, P<0.0001, and 8% vs. 5%, P=0.006 respectively). The prevalence of CRC was higher in men but did not reach statistical significance (0.5% vs. 0.2%, P=0.3). The prevalence of adenomas in the 50-59 year age group was significantly higher in men compared to women (29% vs. 19%, P<0.0001). There was no statistically significant difference in the prevalence of adenomas and AAs among men aged 50-59 years and women aged 60-69 years. In the > 60 year age group, the prevalence of AAs tended to be higher in men compared to women (see Table). Patient numbers were too low in the < 50 year age group to observe gender difference.Table: Prevalence and numbers needed to screen for adenomas, advanced adenomas, and colorectal cancer in different age groups in men and womenConclusion: The overall prevalence of adenomas, AAs, and CRC is higher in men compared to women. The prevalence and NNS of adenomas and AAs is comparable between men aged 50-59 years and women aged 60-69 years suggesting early disease in men.

An Internist Is Able to Successfully Perform Diagnostic Colonoscopy after Training by Gastroenterologists: A Single VA Medical Center Pilot Program to Address the Increasing Demand for Diagnostic and Surveillance Colonoscopy

Purpose: Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related mortality in the United States. Currently the resources required to screen every eligible person using colonoscopy do not exist. In the future, the nation will face a shortage of all physicians, including gastroenterologists. We hypothesized that training a primary care physician with a prior experience in performing flexible sigmoidoscopy through a comprehensive training program supervised by a group of gastroenterologists, could result in the safe performance of quality colonoscopy. Methods: An internist who was interested in performing colonoscopy and had a vast experience in performing flexible sigmoidoscopy was selected. A program was developed for her to learn how to perform colonoscopy which included: watching videos of different colonoscopies and polypectomy techniques, performing colonoscopy on a pig model of colon, training with four gastroenterologists over a period of 14 months followed finally by evaluation by them after performing 100, 200 and 400 colonoscopies. After each benchmark, her cecal intubation rate, and polypectomy techniques were evaluated. Results: She performed a total of 320 independent colonoscopies over a period of 7 months at the Loma Linda VA Hospital. Of the 320 patients, 287 (90%) were males. The mean age and BMI were 63.8 ± 10.6 years and 30.2 ± 6.1, respectively. The majority of patients were Caucasians (n=196 patients, 62%). The main indication was surveillance (n=245, 30%). Her cecal intubation rate was 95% compared to 94% and 93% for gastroenterology fellows and attendings, respectively (p=0.31). The number of colonoscopies during which she found a polyp was 218 (68%) compared to 32 (39%) and 181 (44%) for gastroenterology fellows and attendings, respectively (p < 0.0001). Her adenoma detection rate (ADR) was 56% versus 33% for fellows and 34% for attendings (p < 0.0001). She had no complications.Table: [536] Findings ( n =818)Conclusion: Unfortunately, the capacity for a national colonoscopy screening program is limited secondary to the short supply of gastroenterologists and the unmet demand for colonoscopy for colorectal cancer screening as well as surveillance. We feel that in underserved areas that are unable to keep pace with the demand of colonoscopy, whether the indications are for screening or diagnostic purposes, primary care physicians trained by gastroenterologists may be a valuable asset in providing the standard of medical care for all.

Dietary supplement use is not associated with recurrence of colorectal adenomas: A prospective cohort study

Diet and lifestyle influence colorectal adenoma recurrence. The role of dietary supplement use in colorectal adenoma recurrence remains controversial. In this prospective cohort study, we examined the association between dietary supplement use, total colorectal adenoma recurrence and advanced adenoma recurrence. Colorectal adenoma cases (n = 565) from a former case-control study, recruited between 1995 and 2002, were prospectively followed until 2008. Adenomas with a diameter of ≥1 cm and/or (tubulo)villous histology and/or with high grade dysplasia and/or ≥3 adenomas detected at the same colonic examination were considered advanced adenomas. Hazard ratios (HRs) and 95% confidence intervals (CIs) for dietary supplement users (use of any supplement during the past year) compared to nonusers and colorectal adenoma recurrence were calculated using stratified Cox proportional hazard models for counting processes and were adjusted for age, sex, educational level and number of colonoscopies during follow-up. Robust sandwich covariance estimation was used to adjust for the within subject correlation. A number of 165 out of 565 adenoma patients had at least one colorectal adenoma recurrence during a median person-time of 5.4 years and of these, 37 patients had at least one advanced adenoma. One-third of the total study population (n = 203) used a dietary supplement. Compared to no use, dietary supplement use was neither statistically significantly associated with total colorectal adenoma recurrence (HR = 1.03; 95% CI 0.79-1.34) nor with recurrent advanced adenomas (HR = 1.59; 95% CI 0.88-2.87). This prospective cohort study did not suggest an association between dietary supplement use and colorectal adenoma recurrence.

Tu1219 Expression of a Novel Tropomyosin Isoform in Various Epithelial Cancers

INTRODUCTION:the number of screening colonoscopies worldwide is constantly increasing due to a greater number of countries recognizing advantages of organized screening programs.Nevertheless the question is imposing could the costs of screening program together with follow-up (FU) colonoscopies be foreseen in the future.The University Hospital of Udine began the Bowel Cancer Screening Program (BCSP) in 2008.An estimation of number and cost of post-polypectomy (PP) endoscopic surveillance were performed for the period until 2020 MATERIAL AND METHODS:we review data of 1000 subjects aged 50-69 referred to screening colonoscopy for positive immunochemical fecal test in our center during 2010.At that time AGA guidelines,published in 2008,were used for FU colonoscopies and according to that we estimated prospectively all FU colonoscopies until 2020.Because in these patients could be found further polyps as result of the missing rate of 25% for low risk adenomas and 6% of high risk adenomas,this occurrence corresponds to a further increase in the number of colonoscopies at 3 and 5 years.Finally,a cost evaluation was performed based exclusively on PP colonoscopies(unit cost in Italy: 120 euro per colonoscopy).In the analysis post-cancer resections and interval cancers were excluded RESULTS:one or more adenomas were present in 530 patients (53 %) with a total of 1230 adenomas.Advanced adenomas were 515 in 370 patients (37%).Assuming that the number of screening and post-polypectomy FU colonoscopies would have been stable until 2020, according to the guidelines in use at that time, 370 and 160 subjects were respectively scheduled for FU colonoscopy every 3 and 5 years.A further growth in colonoscopies can result from missing polyps in the same subjects who had PP endoscopic surveillance.In this last setting we evaluated in 22more colonoscopies after 6 years and 165 after 10 years.After a decade the cumulative amount of screening colonoscopies must be added to post-polypectomy surveillance endoscopies plus colonoscopies in subjects positive for polyps during the same PP surveillance. After 10 years, over the 10.000 colonoscopies scheduled for CRC screening program, we need to take in account further 4379 colonoscopies not planned by the screening program (fig.1).In this setting the cost in Italy, not directly linked to the BCSP, could be estimated in additional 525.480 euro. CONCLUSION:colon cancer screening is of paramount importance for health but almost all programs did not take sufficiently in account all other induced costs. Our rough evaluation (who does not include the satellite costs, for example complications, increasing number of screening colonoscopies, etc.) wants only to point out that the load of BCSP does not stop exclusively to the simple colonoscopy screening but it is inevitably followed by a considerable increase in workload and costs

Tu1218 The Burden of CRC Screening: Number and Cost Estimation of Follow-up Colonscopies During CRC Screening Program in a North-Eastern Italian Single Tertiary Center

INTRODUCTION:the number of screening colonoscopies worldwide is constantly increasing due to a greater number of countries recognizing advantages of organized screening programs.Nevertheless the question is imposing could the costs of screening program together with follow-up (FU) colonoscopies be foreseen in the future.The University Hospital of Udine began the Bowel Cancer Screening Program (BCSP) in 2008.An estimation of number and cost of post-polypectomy (PP) endoscopic surveillance were performed for the period until 2020 MATERIAL AND METHODS:we review data of 1000 subjects aged 50-69 referred to screening colonoscopy for positive immunochemical fecal test in our center during 2010.At that time AGA guidelines,published in 2008,were used for FU colonoscopies and according to that we estimated prospectively all FU colonoscopies until 2020.Because in these patients could be found further polyps as result of the missing rate of 25% for low risk adenomas and 6% of high risk adenomas,this occurrence corresponds to a further increase in the number of colonoscopies at 3 and 5 years.Finally,a cost evaluation was performed based exclusively on PP colonoscopies(unit cost in Italy: 120 euro per colonoscopy).In the analysis post-cancer resections and interval cancers were excluded RESULTS:one or more adenomas were present in 530 patients (53 %) with a total of 1230 adenomas.Advanced adenomas were 515 in 370 patients (37%).Assuming that the number of screening and post-polypectomy FU colonoscopies would have been stable until 2020, according to the guidelines in use at that time, 370 and 160 subjects were respectively scheduled for FU colonoscopy every 3 and 5 years.A further growth in colonoscopies can result from missing polyps in the same subjects who had PP endoscopic surveillance.In this last setting we evaluated in 22more colonoscopies after 6 years and 165 after 10 years.After a decade the cumulative amount of screening colonoscopies must be added to post-polypectomy surveillance endoscopies plus colonoscopies in subjects positive for polyps during the same PP surveillance. After 10 years, over the 10.000 colonoscopies scheduled for CRC screening program, we need to take in account further 4379 colonoscopies not planned by the screening program (fig.1).In this setting the cost in Italy, not directly linked to the BCSP, could be estimated in additional 525.480 euro. CONCLUSION:colon cancer screening is of paramount importance for health but almost all programs did not take sufficiently in account all other induced costs. Our rough evaluation (who does not include the satellite costs, for example complications, increasing number of screening colonoscopies, etc.) wants only to point out that the load of BCSP does not stop exclusively to the simple colonoscopy screening but it is inevitably followed by a considerable increase in workload and costs