Reasons For Colonoscopy Research Articles

Prospective study of a multi-modal blood-based test for colorectal cancer screening.

70 Background: Colorectal cancer (CRC) screening has proven to be a useful tool for the detection and prevention of CRC. However, adherence is low despite the multiple screening options available. A blood-based CRC screening test with optimized sensitivity and specificity may improve screening adherence. We aimed to prospectively evaluate the performance of a multimodal blood-based colorectal neoplasia screening test in individuals presenting for colonoscopy. Methods: This prospective, observational study was developed in four hospitals in Spain and enrolled individuals (45 – 84 years of age) undergoing colonoscopy, including diagnostic and screening colonoscopies, between March 2020 and September 2021. Eligible individuals consented to use of medical records for research and to provide a blood sample prior to colonoscopy procedure. Individuals were followed for one year. Whole blood was collected and shipped ambient to a central laboratory for analysis (Shield, Guardant Health, Redwood City, CA, USA). The blood-based colorectal neoplasia test is a 500kb next-generation sequencing based panel and bioinformatic platform that incorporates cell-free DNA (cfDNA) methylation-based partitioning to identify cancer related genomic alterations and epigenomic modifications (methylation and modifications in chromatin state). Results are integrated to yield a binary “positive” or “negative” result. Here we present findings correlating the blood-based test results with colonoscopy findings and findings from available 1-year follow-up data. Results: 556 out of 598 eligible individuals had an evaluable colonoscopy and a blood-based test result that passed quality control standards. Of the 556 individuals, 52% were female; median age was 55 years (21% age 45 – 49, 74% age 50 – 74, 4% age 75+). Reasons for colonoscopy were symptoms (49%), average risk screening (33%), positive stool-based test (6%), positive family history (11%) or other reasons (1%). Colorectal adenocarcinoma prevalence rate was 1.4%. Sensitivity for CRC detection was 100% (8/8; Stage I, 1; Stage II, 3; Stage III, 2; Stage IV, 2). Sensitivity for advanced adenoma (AA) detection was 22%. Specificity for advanced neoplasia (CRC + AA) was 91%. Negative predictive value (NPV) for CRC detection was 100% and positive predictive value (PPV) was 13%. 1-year follow-up data was available for 504 individuals, of whom 9 patients developed cancer (none CRC), of whom 1 had an initial positive Shield result. Conclusions: In this prospective study of individuals eligible for colonoscopy, sensitivity and specificity of the blood-based test showed a performance consistent with the available stool-based non-invasive screening options. This, combined with a more acceptable mode of testing suggests that this blood-based test may be a viable CRC screening option.

Colonoscopy in the nonagenarian population.

With increasing life expectancy, there is an increasing proportion of nonagenarians undergoing both elective and emergency surgical procedures. The decision as to whom will benefit from surgical procedures is however difficult to ascertain and still remains a challenge to clinicians. This study is aimed to evaluate the clinical outcomes of colonoscopy in the nonagenarian population, and to determine if the outcomes are acceptable for us to continue to offer such interventions. Retrospective study of patients of Dr. G.R (Gastroenterologist) and Dr. W.B (Colorectal Surgeon) between 1 January 2018 and 31 November 2022. All patients who were ≥90 years old and had a colonoscopy was included in the study. Exclusion criteria were patients who were less than 90 years old, had a flexible sigmoidoscopy or colonoscopy as part of their surgical procedure. post-colonoscopy complications and length of stay. reasons for colonoscopy, significant colonoscopy findings, 30-day morbidity and mortality. Sixty patients were included in the study. Median age was 91 (90-100) years old. 33.3% of the patients were males. Seventy percent of the patients were ASA 3. Median length of hospital stay was 1day. 11.7% of patients were found to have colorectal malignancy. There were no complications after the colonoscopy. There were no 30-day re-admission, morbidity or mortality. Colonoscopy can be performed safely in carefully selected nonagenarian patients with acceptable low complication rates.

Factors of easy and difficult cecal intubation during unsedated colonoscopy.

difficulty of cecal intubation should be a main indicator for the need of sedated colonoscopy and skilled endoscopists. The present study aimed to explore the factors associated with easy and difficult cecal intubation in unsedated colonoscopy. all consecutive patients who underwent unsedated colonoscopy at our department by the same endoscopist from December 3, 2020 to August 30, 2022 were retrospectively collected. Age, gender, body mass index (BMI), reasons for colonoscopy, position change, Boston Bowel Preparation Scale score, cecal intubation time (CIT) and major colonoscopic findings were analyzed. CIT < 5 min, CIT 5-10 min and CIT > 10 min or failed cecal intubation were defined as easy, moderate and difficult cecal intubation, respectively. Logistic regression analyses were performed to identify independent factors associated with easy and difficult cecal intubation. overall, 1,281 patients were included. The proportions of easy and difficult cecal intubation were 29.2 % (374/1,281) and 27.2 % (349/1,281), respectively. Multivariate logistic regression analysis found that age ≤ 50 years, male, BMI > 23.0 kg/m2 and the absence of position change were independently associated with easy cecal intubation, and that age > 50 years, female, BMI ≤ 23.0 kg/m2, position change, and insufficient bowel preparation were independently associated with difficult cecal intubation. some convenient factors independently associated with easy and difficult cecal intubation have been identified, which will be potentially helpful to determine whether a colonoscopy should be sedated and a skilled endoscopist should be selected. The current findings should be further validated in large-scale prospective studies.

The indications for performing colonoscopy in Iranian children – a cross-sectional study

Background: Colonoscopy is the gold standard dia­gnostic method for colon diseases providing an excellent view of the mucosal surface of the colon and terminal ileum. Colonoscopy in children is indicated for dia­gnosis and treatment of gastrointestinal diseases. In this study, we evaluated the reasons for performing colonoscopy in children. Methods: This was a descriptive cross-sectional study including all children referred for colonoscopy to the Gastroenterology clinic affiliated with the Shiraz University of Medical Sciences. The children were selected by a convenient sampling method. Statistical analysis was conducted in the SPSS 22 software. Results: From 389 children referred for colonoscopy, 203 were boys and 186 were girls. The mean age was 8.36 ±4.8 years. The most common reason for colonoscopy was rectal bleeding (63.5%) with the most prevalent dia­gnoses being juvenile polyp and inflammatory bowel disease, each accounting for 11.3% patients. Conclusions: The most common findings of colonoscopy were polyp, IBD and colon inflammation, and the most prevalent symptoms leading to colonoscopy were rectal bleeding, chronic diarrhea, IBD treatment follow-up, suspected IBD and abdominal pain. The high prevalence of pediatric patients presenting with these symptoms indicates the increasing importance of colonoscopy in these patients. Keywords colonoscopy, gastrointestinal bleeding, inflammatory bowel disease, gastrointestinální onemocnění

Post-colonoscopy diverticulitis: A systematic review.

BACKGROUNDPost-colonoscopy diverticulitis is increasingly recognized as a potential complication. However, the evidence is sparse in the literature.AIMTo systematically review all available evidence to describe the incidence, clinical course with management and propose a definition.METHODSThe databases PubMed, EMBASE and Cochrane databases were searched using with the keywords up to June 2020. Additional manual search was performed and cross-checked for additional references. Data collected included demographics, reason for colonoscopy, time to diagnosis, method of diagnosis (clinical vs imaging) and management outcomes.RESULTSA total of nine studies were included in the final systematic review with a total of 339 cases. The time to diagnosis post-colonoscopy ranged from 2 h to 30 d. Clinical presentation for these patients were non-specific including abdominal pain, nausea/vomiting, per rectal bleeding and chills/fever. Majority of the cases were diagnosed based on computed tomography scan. The management for these patients were similar to the usual patients presenting with diverticulitis where most resolve with non-operative intervention (i.e., antibiotics and bowel rest).CONCLUSIONThe entity of post-colonoscopy diverticulitis remains contentious where there is a wide duration post-procedure included. Regardless of whether this is a true complication post-colonoscopy or a de novo event, early diagnosis is vital to guide appropriate treatment. Further prospective studies especially registries should include this as a complication to try to capture the true incidence.

Impact of a Telephone Intervention on Bowel Preparation Quality for Colonoscopy in the Elderly.

Bowel preparation is the basis of colonoscopy, and adequate bowel preparation is essential to the success of colonoscopy. Studies have been reported that telephone intervention can improve the quality of bowel preparation, while it remains unclear regarding effectiveness with the elderly. The purpose of this study was to evaluate the effect of telephone intervention on the quality of bowel preparation for colonoscopy in elderly outpatients. In total, 162 outpatients older than 65 years were enrolled and randomly divided into a control group and a study group. Patients in the study group were re-educated through telephone by a specific nurse 2 days before colonoscopy, whereas participants in the control group received education only on the day of appointment. The Ottawa score was used to evaluate the quality of bowel preparation between the two groups. In this study, no significant differences were observed in age, gender, body mass index, educational level, smoking and/or alcohol drinking, waiting time to colonoscopy, reasons for colonoscopy, and colonoscopic findings between the control group and the study group. Participants in the study group had higher adequate bowel preparation and compliance than the control group (83.1% vs. 59.5%, p = .03; 96.4% vs. 74.7%, p < .001). Univariate analysis showed that only noncompliance with start time was significantly associated with satisfactory bowel preparation in elderly patients. In conclusion, telephone intervention 2 days before colonoscopy can improve the quality of bowel preparation in the elderly.

Post-colonoscopy appendicitis: Systematic review of current evidence.

Appendicitis after colonoscopy is an exceedingly rare complication. It remains to be explored if this entity is truly a complication of colonoscopy or a coincidental occurrence of appendicitis post-colonoscopy. The aim of this study was to systematically review all the available evidence since it was first described in 1988. The literature on post-colonoscopy appendicitis was searched using PubMed, EMBASE, and Cochrane databases. Additional manual search was performed and cross-checked for additional references. The search was performed up to November 2019. Data collected included demographics, reason for colonoscopy, time to diagnosis, imaging performed, management, and outcome. Fifty-three cases were found in the systematic review with a median age of 55years (24-84years). The time to diagnosis post-colonoscopy was mostly within 24-48h. Clinical features mimicked those of common acute appendicitis. In the past decade, computed tomography scan has been the imaging choice to investigate abdominal pain after colonoscopy, mainly to rule out perforation. The mainstay of management was appendectomy (open or laparoscopy). Four of the 12 cases (33.3%) were treated successfully with antibiotics alone. There has been a twofold increase in cases reported in the past decade (2009-2019, n=31 vs 1999-2008, n=15). There is a considerable variation in the definition of post-colonoscopy appendicitis in the current literature. Regardless of whether post-colonoscopy appendicitis is a true entity, it should be considered as a differential diagnosis in any patient presenting with acute abdomen following colonoscopy.

Abstract 3159: Do molecular markers differentiate between sessile serrated adenoma/polyps and hyperplastic polyps

Abstract Background: A significant proportion of colorectal cancers, as much as up to 30%, develop through the alternate serrated pathway. The precursor lesions in this pathway comprise of sessile serrated adenomas or polyps (SSA/SSPs) and hyperplastic polyps (HPs), both with a varying risk-profile associated with them for progression into colorectal cancer. Although both types of polyps can be identified histologically, the clinical challenge for gastroenterologists and pathologists remain for risk-prediction as to which of these polyps have a higher likelihood for subsequent development and progression into colorectal cancer. These data highlight the imperative need for the development of more specific and objective markers that can adequately differentiate between the two types of colonic polyps. Aim: The aim of our study was to determine a variety of molecular biomarkers that may distinguish SSA/Ps and HPs, and to establish biomarker profiles that associate with low vs. high-risk SSA/Ps. Methods: We conducted a retrospective study of all colonoscopies (n=12,085) performed at the Howard University Hospital between January 2010 to December 2015; of which 83% were conducted in patients of African American (AA) descent (n=10,027). Among AAs, pathology reports confirmed 4,070 patients with polyps, including 252 with SSA/Ps. Gene expression and mutation frequency profiles were analyzed in a total of 47 patients which included 62 specimens (29 SSPs, 26 HP, 3 tubular adenomas (TA) and 4 normal colonic tissues). From a panel of 51 candidate transcripts, we validated 4 RNA markers (MUC6, FSCN1, SEMG1, and TRNP1) using qRT-PCR. MSI and BRAF mutations were also analyzed. CIMP analysis was performed for the aberrant methylation of CACNA1G, IGF2, NEUROG1, RUNX, SOCS and MLH1. The frequency of gender, age groups, anatomic location, clinical/pathological symptoms and reason for colonoscopy in SSA/P patients was analyzed. The median age range for SSA/P diagnosis was between 50 to 64 years. Results: MUC6, SEMG1, TRNP1, and FSCN1 expression was significantly higher in SSA/Ps vs. HPs (P &amp;lt; 0.05); with corresponding fold differences of 37.2 10.7, 5.8 and 2.5, respectively. BRAF mutations were found in 55.6% of SSA/Ps as opposed to 12.0% of HPs (P &amp;lt; 0.05). The frequency of CIMP was higher in SSA/Ps and correlated with BRAF mutation, while the degree of MSI was more prevalent in HP (P &amp;gt; 0.05). SSA/P lesions were distal (67%). Conclusion: Our results show that MUC6 and SEMG1 expression and BRAF mutation have the strongest correlation with SSA/Ps in comparison to HPs. In addition, SSA/Ps were predominantly distal in location. These are novel and distinguishing features compared to the published literature in non-AA populations and may help explain why MSI and CIMP, usually linked to proximal lesions, are not optimal molecular biomarkers in AA patients with such serrated lesions. Note: This abstract was not presented at the meeting. Citation Format: Hassan Ashktorab, Saman Azam, Taraneh Tarjoman, Priyanka Kanth, Edward Lee, Mehdi Nouraie, Nazli Atefi, Babak Shokrani, Adeyinka Laiyemo, Ajay Goel, Mark W. Hazel, Ruoxin Yao, Angela Snow, Deborah Neklason, Don Delker, Hassan Brim. Do molecular markers differentiate between sessile serrated adenoma/polyps and hyperplastic polyps [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3159.

Abstract 5273: Detection of sessile serrated adenomas/polyps in African Americans

Abstract Introduction: The majority of colorectal cancers (CRCs) develop through the adenoma-carcinoma sequence, while 15-20% develop via the serrated pathway. Sessile Serrated Adenoma/Polyps (SSA/P) are more difficult to detect during colonoscopy and generally require a shorter time follow-up than other lesions (3 vs. 5 years). These polyps lead to cancer faster than conventional adenomas. In order to better define patients at risk for these lesions, we performed a retrospective study to evaluate clinicopathological features of patients diagnosed with SSA/P. Methods: We reviewed pathology reports of patients at Howard University Hospital from 2010-2015. We identified 5,900 patients with colorectal lesions, of whom 312 (5.3%) were diagnosed with SSA/P. We analyzed the specific clinical, pathological and demographic features of patients with SSA/P lesions. Results: We identified 312 cases with SSA/P. The incidence of SSA/P over the 5 years period was 5.3%: 198/312 (63.4%) patients had 2 or more polyps, 54.5% of the SSA/P patients were females, 70.5% of patients were 50-64 years of age and 18% were older than 65. SSA/P lesions’ locations were as follows: rectal: 32.1%; rectosigmoid: 18.6%; sigmoid: 16.8%; Ascending Colon: 13.2 % and Descending Colon: 7.1%. Reasons for colonoscopy were as follows: Screening: 43.6 %; GI bleeding: 15.1%; Abdominal Pain: 13.1%and Change in Bowel Habits: 10.2%. Conclusion: Our results show that there is a slightly increased predominance of SSA/P occurrence in females. Most SSA/P occurred in patients 50 to 64 years old. This age range is younger in comparison to patients with conventional adenomas. SSA/Ps were predominantly distal (rectal, rectosigmoid, sigmoid) whereas previous literature reports a proximal location. Most patients in our study were diagnosed in screening colonoscopies; however, other patients presented with symptoms such as GI bleeding, abdominal pain, or change in bowel habits. Citation Format: Nazli Atefi, Sanmet Singh, Babak Shokrani, Edward Lee, Ali Afsari, Mehdi Nouraie, Adeyinka Laiyemo, Joseph Mathews, Carla Williams, Hassan Brim, Hassan Ashktorab. Detection of sessile serrated adenomas/polyps in African Americans [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5273. doi:10.1158/1538-7445.AM2017-5273

Molecular Screening for Lynch Syndrome in Young Patients With Colorectal Adenomas

BackgroundThe frequency of mismatch repair (MMR) deficiency (dMMR) in patients < 50 years with adenomas without a known germline mutation is unknown. Our aim was to define the frequency of dMMRs in adenomas from patients aged < 50 years. Patients and MethodsWe identified all patients aged 18 to 49 years who had undergone colonoscopy at Memorial Sloan Kettering Cancer Center from 2008 to 2013 and were identified as having tubular, villous, or tubulovillous adenomas on pathology. Patients with a personal history of colorectal cancer, polyposis syndrome, or inflammatory bowel disease before colonoscopy were excluded. Age, demographic data, family history of cancer, personal history of cancer, use of radiation, reason for colonoscopy, and colonoscopy findings were recorded. Polyps were stained using immunohistochemistry for MLH1, MSH2, MSH6, and PMS2 proteins. ResultsA total of 208 patients with 266 polyps were identified. Of the 266 polyps, 259 could be stained. Of the 208 patients, 82 (40%) were men; their mean age was 44 years. The indication for colonoscopy was screening for 120, diagnostic for 75, and therapeutic for 15. Of the 259 examined polyps, 246 (95%) were tubular adenomas and 13 were tubulovillous adenomas (5%). One patient (0.4%) was found to have dMMRs in 1 polyp. This patient was a 42-year-old woman with a history of endometrial cancer who had undergone colonoscopy for hematochezia. A 15-mm transverse tubular adenoma was found that was deficient in MLH1 and PMS2. ConclusionOur results indicate that routine screening of polyps in patients aged < 50 years old is not an effective tool for identifying Lynch syndrome carriers.

Abstract A26: Diet quality vs quantity in relation to the fecal microbiome among colonoscopy patients

Abstract Diet remains a promising target with the potential to impact colorectal cancer risk via the balance of energy and body weight, as well via specific food components with known anti-carcinogenic properties. Growing evidence implicates the importance of the gut microbiome in the interaction of diet, energy balance, and inflammation—key mechanisms associated with colorectal cancer development. The tight coupling of diet and the gut microbiota may hold new answers for colorectal cancer prevention. Methods: We conducted a pilot epidemiologic study among 50 cancer-free MD Anderson colonoscopy patients with no underlying familial/genetic or chronic inflammatory bowel conditions. With the overall goal to identify dietary intervention targets in obese and lean individuals at varied risk of colorectal neoplasia, patients provided fasting blood at colonoscopy, stool samples via mail ~ 1 month post-polypectomy, and comprehensive dietary assessments. Total energy intake was derived from responses to both the Diet History (DH) and 24-hour dietary recalls (24HR) and diet quality was defined by the Healthy Eating Index (HEI). We conducted 16S rRNA gene sequencing of the fecal microbiota and measured circulating blood adipocytokines via Luminex multiplex assays (Millipore). Results: Majority of colonoscopy patients recruited into the study were female (67%) and diagnosed with precancerous colorectal polyps (57%), primarily tubular and sessile serrated adenomas. Patients with precancerous polyps removed at colonoscopy were more likely to be obese than patients without precancerous polyps, but otherwise similar by age, macronutrient composition, and HEI. Differences in the overall composition of the fecal microbiome via weighted and unweighted unifrac were observed by reason for colonoscopy (symptomatic vs asymptomatic screening), chronic medication use (yes vs. no), total energy and alcohol intake (tertiles); and effects of each these factors were considered in subsequent analyses. No differences were observed by other clinicopathologic features, demographics, or lifestyle factors. High total energy intake was significantly correlated with higher alpha diversity of the fecal microbiome. This linear relationship remained following adjustment for diet quality and was consistent across colonoscopy status, BMI, medication use and alcohol intake (FDR-adj P&amp;lt;0.05). Total energy intake was inversely correlated with the relative abundance of Bacteroides (r2=0.27; FDR-adj P&amp;lt;0.001), while diet quality was positively associated with multiple bacteria involved in short chain fatty acid metabolism, including Faecalibacterium, Subdoligranulum, and Pseudobutyrivibrio (all P&amp;lt;0.05). Many of these same bacteria were significantly correlated with blood levels of circulating adipocytokines, including C-peptide, TNF-alpha, lipocalin-2, and PAI-1. Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) analysis further revealed that gut bacteria may mediate the relationship between diet quality and adipocytokine signaling pathways. Conclusion: Modifiable aspects of diet quality and quantity were more closely linked to the composition of the gut microbiome than obesity or a recent diagnosis of precancerous colorectal polyps. In general, low microbial diversity has been associated with states of disease/poor health, but in our case, eating more may mean exposure to a more varied diet, promoting proliferation of a number of distinct bacteria, both “good” and “bad”. We plan to further explore functional relationships and pathways between diet, the microbiome, and adipocytokines with ongoing metagenomic analysis of the fecal microbiome. Citation Format: Carrie R. Daniel, Kristi L. Hoffman, Akhil Sood, G.S. Raju, Samir M. Hanash, Xifeng Wu, Joseph F. Petrosino. Diet quality vs quantity in relation to the fecal microbiome among colonoscopy patients. [abstract]. In: Proceedings of the AACR Special Conference on Colorectal Cancer: From Initiation to Outcomes; 2016 Sep 17-20; Tampa, FL. Philadelphia (PA): AACR; Cancer Res 2017;77(3 Suppl):Abstract nr A26.

Clinicopathological Features of Sessile Serrated Polyp/Adenoma: Improving Serration Detection to Adjust Interval Follow-up Colonoscopy

Introduction: The majority of colorectal cancers (CRCs) develop through the adenoma-carcinoma sequence, while 15-20% develop via the serrated neoplasia pathway. Sessile Serrated Adenoma/Polyp (SSA/P) is more difficult to detect during colonoscopy, leading to a disproportionate contribution to interval carcinoma (CRCs diagnosed within 6-36 months of colonoscopy). These polyps lead to cancer faster than conventional adenomas. In order to better define patients at risk for these lesions, we performed a retrospective study to evaluate clinicopathological features of patients diagnosed with SSA/P. Methods: We reviewed the pathology reports of patients at Howard University Hospital from 2010-2015. We identified 5,900 patients with polyps, of whom 312 (5.3%) were diagnosed with SSA/P. We presented the frequency of gender, age groups, anatomic location, clinical symptoms and reason for colonoscopy in SSA/P patients. Results: We identified 312 cases with SSA/P. The incidence of SSA/P over that 5-year period was 5.3%. 198/312 (63.4%) patients had 2 or more polyps. 54.5% of the patients diagnosed with SSA/P were females. 70.5% of patients were 50-64 years of age and 18% were older than 65. SSA/P lesions' locations were as follows: rectal -32.1%; rectosigmoid -18.6%; sigmoid - 16.8%; Ascending Colon - 13.2 %; Descending Colon - 7.1%. Reasons for colonoscopy were as follows: Screening - 43.6 %; GI bleeding - 15.1%; Abdominal Pain - 13.1%; Change in Bowel Habits - 10.2%. Conclusion: Our results show that there is a slightly increased predominance of SSA/P occurrence in females. The most common age range for an SSA/P diagnosis is from 50 to 64 years. This age range is younger in comparison to patients with conventional adenomas. We also found that SSA/P was predominantly distal (rectal, rectosigmoid, sigmoid) whereas previous literature reports a proximal location for SSA/P. Most patients in our study were diagnosed in screening colonoscopies; however, other patients presented with symptoms such as GI bleeding, abdominal pain, or change in bowel habits.Figure 1Figure 2Figure 3

Comparison of Characteristics of Colorectal Cancer Patients and Outcomes in African Americans Versus Caucasians in a Veteranʼs Affairs Medical Center

Introduction: Colorectal cancer (CRC) is the third leading cause of mortality due to cancer in the United States. Compared to Caucasians, African American men have incidence and mortality rates 25% and 50% higher respectively from CRC as well as lower CRC screening uptake. Poverty and health insurance status remains a key determinant of CRC screening uptake. In this study, we compared the characteristics of CRC patients as well as their outcomes in African Americans vs. Caucasians in a health care system that affords similar access to health care among the Veterans. Methods: We updated the records of male patients diagnosed with colorectal cancer between 2003 and 2012 at a VA medical center for demographics including race, stage, reason for colonoscopy, treatment modalities and survival. Statistical analysis was performed using SPSS v22. Results: We analyzed 263 men. 108 (39.0%) patients were African Americans (AA) and 155 (61.0%) were Caucasians in this study. Median age was 69 (43-89) years among African Americans and 70 (44-92) in Caucasians. 29 (26.9%) AA patients were diagnosed by screening colonoscopy, 26 (24.1%) diagnosed by asymptomatic anemia and 53 (49.1%) diagnosed by symptoms. 40 (25.5%) were diagnosed by screening colonoscopy, 32 (20.6%) by asymptomatic anemia and 83 (53.5%) by symptoms. On univariate analysis, there was no statistically significant difference in the distribution by stage of colorectal cancer presentation between the two racial groups (p=0.126). There was also no significant difference in patterns of treatment with chemotherapy and surgery at different stages in African Americans vs. Caucasians. The 5 year overall survival rate in African Americans was 52.6% compared to 54.5% in Caucasians, 10 year overall survival rate was 33.2% vs. 34.3% in African American and Caucasians respectively. Conclusion: Racial disparities are well known to exist in the diagnosis and management of colorectal cancer. In our VA health care system, the 5 and 10 year survival among AA compared with Caucasians were found to be similar. This suggests eliminating financial barriers to health care might be a key target in addressing colorectal cancer racial disparities. Further studies are needed.Table 1: Characteristics of Colorectal Cancer Patients in African Americans vs. Caucasians in a Veteran's Affairs Medical CenterTable 2: Outcomes of Colorectal Cancer Patients in African Americans vs. Caucasians in a Veteran's Affairs Medical Center

The Impact of Sexual Abuse in Patients Undergoing Colonoscopy

BackgroundSexual abuse has been linked to strong effects on gastrointestinal health. Colonoscopy can provoke intense emotional reactions in patients with a sexual abuse history and may lead to avoidance of endoscopic procedures.ObjectiveTo determine whether care around colonoscopy needs adjustment for patients with sexual abuse experience, thereby exploring targets for the improvement of care around colonoscopic procedures.MethodsQuestionnaires were mailed to patients (n = 1419) from two centers within 11 months after colonoscopy. Differences in experience of the colonoscopy between patients with and without a sexual abuse history were assessed and patients' views regarding physicians' inquiry about sexual abuse and care around endoscopic procedures were obtained.ResultsA total of 768 questionnaires were analyzed. The prevalence of sexual abuse was 3.9% in male and 9.5% in female patients. Patients born in a non-western country reported more sexual abuse (14.9%) than those born in a western country (6.3%; p = 0.008). Discomfort during colonoscopy was indicated on a scale from 0 to 10, mean distress score of patients with sexual abuse was 4.8(±3.47) compared to 3.5(±3.11) in patients without a sexual abuse history (p = 0.007). Abdominal pain was a predictor for higher distress during colonoscopy (β = −0.019 (SE = 0.008); p = 0.02, as well as the number of complaints indicated as reason for colonoscopy (β = 0.738 (SE = 0.276); p = 0.008). Of patients with sexual abuse experience, 53.8% believed gastroenterologists should ask about it, 43.4% said deeper sedation during colonoscopy would diminish the distress.ConclusionsSexual abuse is prevalent in patients presenting for colonoscopy. Patients with a sexual abuse history experience more distress during the procedure and indicate that extra attention around and during colonoscopy may diminish this distress.

Comparison of Colorectal Cancer (CRC) Patients by Reasons for Colonoscopy at Diagnosis

Purpose: We studied and compared the characteristics and survival for patients (pts) with CRC diagnosed by colonoscopy for different reasons. Methods: In an IRB-approved protocol, we reviewed the records of pts diagnosed with CRC at a VA medical center from 01/01/2003 to 12/31/2011 for demographics, stage, grade, ECOG performance status (ECOG PS), primary site (rectum or colon), and reasons for the colonoscopy at diagnosis: screening, asymptomatic anemia, or symptoms. Statistical analyses were performed with SAS 9.2/Stata 11.0. Results: There were 279 men. 275 pts had documented reasons for colonoscopy and were analyzed. Median (M) age was 70 (43-95) years. 85 (30.9%) pts were diagnosed from screening colonoscopy, 37 (13.5%) pts by asymptomatic anemia, and 153 (55.6%) pts by symptoms. There were no significant differences by age, race, and grade among the three colonoscopy groups. On univariate analyses, significant differences were found between the three groups for ECOG performance status, stage, primary tumor site, and survival (p=0.007; see figure and table). Rectal cancer is more likely to be diagnosed in patients undergoing diagnostic colonoscopy for symptoms. In multivariate model that included age, stage, and grade, reason for colonoscopy was a predictor for survival (p<.007). When ECOG performance status was added, reason for colonoscopy was no longer a predictor for survival (p=0.112).Table: Table. Comparison of CRC patients by reasons for colonoscopyConclusion: The reasons for colonoscopy at the time of diagnosis of CRC identify patients with CRC with different ECOG PS, stage, and primary site. Rectal cancer is more likely to be diagnosed in patients undergoing colonoscopy for symptoms. Emphasis should be placed on preventive screening colonoscopies. More studies are needed.Figure

Prevalence and predictive factors of the need for surgery for advanced colorectal adenoma

Endoscopic resection is the primary treatment for colorectal adenoma, but in some cases surgery is necessary. The aim of this retrospective study was to define the prevalence and predictive factors for surgery in patients with advanced colorectal adenoma managed in a referral endoscopy centre. Consecutive patients diagnosed with advanced adenoma (Class 4 in the Vienna classification) during a colonoscopy from 2007 to 2009 in the endoscopy centre of the University Hospital of Rennes were included. Predictive factors of surgery were determined by univariate and multivariate analysis. Two-hundred and twelve (135 male) patients with a mean age of 65.8 years were included. The reason for colonoscopy was for diagnosis in 63.2%, surveillance in 25.5% and screening in 11.3%. These referred patients amounted to 20.8% of all patients having colonoscopy. Surgery was performed in 13.7% of the 212 patients and in 16 (8.3%) of the 192 patients in whom endoscopic removal was attempted. In the subgroup of 192 patients, univariate analysis revealed that body mass index (P = 0.04), histology (P = 0.002), size (P = 0.03) and macroscopic appearance (P < 0.001) of the polyp were associated with surgery. Multivariate analysis revealed that the macroscopic appearance and histology only were significantly associated with surgery. Surgery was needed in 13.7% of patients with an advanced adenoma, but in only 8.3% of the subgroup of 192 patients in whom endoscopic removal was attempted. Factors associated with surgery included macroscopic appearance and histology.

Mo1412 Quality of Endoscopic Mucosal Resection (EMR) as an Indicator of Quality of Colonoscopy

criterion was that informed consent should be obtained from all patients undergoing colonoscopy in each center. Exclusion criteria included the following: age of 39 years or lower, inflammatory bowel disease, familial adenomatous polyposis, patients whose bowel preparation was inadequate, patients who had undergone colonoscopy in the past 6 months, patients who could not be observed up to the cecum although stenotic CRC did not exist, and patients who were already diagnosed with colorectal tumors but not treated. All procedures were performed or supervised by experienced endoscopists at each center. We collected data of age, sex, past history of CRC, family history of CRC, and reasons for colonoscopy. The relationship between the frequency of colonoscopy in the past 5 years and detection rate of advanced adenoma or CRC was analyzed. The Cochran-Armitage test was used to assess trends in the incidence proportions of outcomes. To adjust for risk factors, we used multiple logistic regression to estimate odds ratios. Results: A total of 5818 patients were finally analyzed. When the frequency of colonoscopy over the past 5 years increased, the detection rate of advanced adenoma or CRC tended to decrease (p 0.01). Table 1 shows the odds ratio of advanced adenoma. However, if the examination frequency over the past 5 years increased, the odds ratio did not decrease more than approximately 70%. Table 2 shows the odds ratio of CRC. CRC was not detected in most patients who underwent colonoscopy twice in the past 5 years. Conclusions: Our results indicate that undergoing colonoscopy twice in 5 years is recommended to prevent CRC.

Recommendations for Post-Polypectomy Surveillance in Community Practice

After colon cancer screening, large numbers of persons discovered with colon polyps may receive post-polypectomy surveillance with multiple colonoscopy examinations over time. Decisions about surveillance interval are based in part on polyp size, histology, and number. To learn physicians' recommendations for post-polypectomy surveillance from physicians' office charts. Among 322 physicians performing colonoscopy in 126 practices in N. Carolina, offices of 152 physicians in 55 practices were visited to extract chart data, for each physician, on 125 consecutive persons having colonoscopy in 2003. Subjects included persons with first-time colonoscopy and no positive family history or other indication beyond colonoscopy findings that might affect post-polypectomy surveillance recommendations. Data were extracted about demographics, reason for colonoscopy, family history, symptoms, bowel prep, extent of examination, and features of each polyp including location, size, histology. Recommendations for post-polypectomy surveillance were noted. Among 10,089 first-time colonoscopy examinations, hyperplastic polyps were found in 4.5% of subjects, in whom follow-up by 4-6 years was recommended in 24%, sooner than recommended in guidelines. Of the 6.6% of persons with only small adenomas, 35% were recommended to return in 1-3 years (sooner than recommended in some guidelines) and 77% by 6 years. Surveillance interval tended to be shorter if colon prep was less than "excellent." Prep quality was not reported for 32% of examinations. Surveillance intervals after polypectomy of low-risk polyps may be more aggressive than guidelines recommend. The quality of post-polypectomy surveillance might be improved by increased attention to guidelines, bowel prep, and reporting.

Tu1447 Teaching and Assessing Competence in Small Bowel Capsule Endoscopy During Gastroenterology Fellowship

age: 59 yrs (SD:14); male 49%). Previous colonoscopy experience was reported by 47% of patients.The mean waiting for their colonoscopy was 4.3 weeks (range: 3.1-5.8). Patients who had to wait 4 weeks were more dissatisfied with timeliness compared to those who had their procedure scheduled 4 weeks (30 vs. 6%, p 0.01). The reason for colonoscopy was not recalled by 7% of cases. Information about the complications perforation and bleeding from an endoscopy professional was not recalled by respondents in 54% (range between units: 1-79%, p 0.01) respectively 50% (range: 12-78%, p 0.01). Satisfactory scores were found in the courtesy of nurses (94%) and the competency of the endoscopist (93%). Discomfort during colonoscopy was reported by 20% (range: 8-40%, p 0.01); 5% reported an unacceptable procedure. Privacy in the recovery area was satisfactory in 76% (range: 66-90%, p 0.05). Adequate explanation about the findings was provided to 75% (range: 52-86%, p 0.01). A majority (79%) reported to be sufficiently informed about what to do when problems after discharge would arise (range: 43-98%, p 0.01). 85% of subjects were willing to return for colonoscopy (range: 72-91%, p 0.01). Factors associated with willingness to return were male gender (OR: 1.7, p 0.02), cecal intubation (OR: 2.9, p 0.01), low levels of discomfort during bowel preparation (OR: 4.4, p 0.01), high acceptance of the experience (OR: 3.4, p 0.01) and less discomfort than expected (OR: 2.7, p 0.01). Conclusion The overall patient experience during colonoscopy procedures in Dutch endoscopy units was satisfactory, reflected in a high willingness to return for colonoscopy. However, differences were found between units in GRS items information and privacy. This study shows that GRS items are applicable to endoscopy units outside the UK.

Malakoplakia of the Gastrointestinal Tract: Prevalence and Clinicopathological Associations

Purpose: Malakoplakia (MP) is a rare granulomatous condition thought to result from the insufficient killing of bacteria by macrophages; it is of uncertain clinical significance and can occur at any tissue site. It may be focal or widespread, involving multiple organs. Gastrointestinal MP has been described in association with a variety of conditions such as ulcerative colitis, diverticulitis, adenomatous polyps, and carcinoma. It has been reported to cause rectal bleeding, diarrhea, abdominal pain and simulate polyps or masses. This study reports on the clinicopathologic associations in a series of 8 patients. Methods: This study was conducted at Caris Life Sciences, a specialized gastrointestinal laboratory receiving specimens from outpatient endoscopy centers across the US. Biopsies are interpreted by a group of gastrointestinal pathologists who have achieved a high level of diagnostic agreement by using uniform diagnostic criteria and terminology. We analyzed electronic data from the Caris database, which includes demographic, clinical, and endoscopic information for each patient, the site of origin and the histopathologic report for each biopsy. From a series of over 600,000 patients who underwent upper or lower endoscopies with mucosal biopsies between January 2009 till May 2010, we extracted data for all patients who had a histopathologic diagnosis of MP. Results: There were 8 patients with MP, 7 women and one man, aged 26 to 85 years. Two patients were from LA, and one each from NC, PR, FL, AZ, MD and CA. MP was detected exclusively at a single site in the colon in all cases. No patient had MP in the upper gastrointestinal tract or the small intestine, and none had evidence of diffuse disease. MP was detected in lesions submitted as polyps in all cases: 3 polyps were from the cecum, 3 from the rectum, and one each from sigmoid and ascending colon. Reasons for colonoscopy were: screening for colorectal cancer in 4 patients, bowl habits changes (2 patients), diarrhea (1 patient), and abdominal pain (1 patient). Von Kossa and iron stains showed the diagnostic Michaelis-Gutman bodies in all cases. No previous history of infection, immunosuppression, or other relevant condition was reported in any of the patients. Conclusion: This series confirms that MP is an extremely rare condition, with a prevalence of <0.8 in 100,000 patients with gastrointestinal mucosal biopsies. MP was restricted to the colon in all cases. Clinical presentations were varied: four patients were asymptomatic and the others had changes of bowel habits that may not necessarily be related to MP. All cases were detected in polypoid formations. No MP was identified in “classic” cold climate states/territories.