COLORECTAL CANCER PREVENTION

S626 Abstracts while two out of 35 (5.7%) patients with normal UGI (pre GT) required fundoplication within a year of GT placement (Table 2). Conclus...
Author: Richard Burke
0 downloads 2 Views 2MB Size
S626

Abstracts

while two out of 35 (5.7%) patients with normal UGI (pre GT) required fundoplication within a year of GT placement (Table 2). Conclusion: 1. Normal pH probe study may have better predictive value to determine the need for future fundoplication in patients with GT placement. 2. More studies are needed to validate need for fundoplication in patients with abnormal pH study prior to GT placement. 3. Upper GI study may detect anatomical abnormality prior to GT placement.

[2061] Table 1. 24-hour esophageal pH monitoring (total 79) and UGI series results (total 53) compared with method of GT placement Abnormal upper GI results

Normal pH probe results

Abnormal pH probe results

Normal upper GI results

PEG

33

18

23

7

Surgical GT

11

9

12

4( + )

Surgical GT and FP at the same time

0

8

5

2

PEG then later FP

1

1(*)

1

1

Surgical GT then later FP

0

2**(*)

1

1

Total PEG/GT then later FP

1

3

2

2

*Attempted PEG-J tube. **Patient had pH probe after surgical GT placement. + Hiatal hernia in 1 patient

Methods: We conducted a survey on PGI and GIF who attended the 2012 William M. Steinberg Board Review course in Gastroenterology. The attendees at this course were from all of the United States and Puerto Rico. The survey instrument asked the following questions: 1.) You see a 30-year-old woman in your practice whose father had colon cancer at age 70. At what age do you advise beginning screening colonoscopy? 2.) If the colonoscopy is negative, how many years later do you advise a repeat procedure? In addition, physicians were asked if they were aware of the 2008 ACG screening guidelines for individuals with family histories of CRC. Results: Of the 399 attendees, 225 (56.4%) completed the survey. 64 were identified as GIF and 161 as PGI. PGI were stratified into 3 categories based on the number of years in practice (0-10 yrs [n= 71], 11-20 yrs [n=58] and >20 yrs [n=31]). 97% of the GFI, 78% of 1-10 yr PGI, 87% of 11-20 yr PGI and 84% of >20 yr PGI stated that they were aware of the 2008 ACG guidelines (p=0.146). For question one (above), 78% of GIF, 64% of 1-10 yr PGI, 67% of 11-20 yr PGI, and 62% of >20 yr PGI stated they would start screening at age 50 (p=0.124) and the rest answered they would start screening before the age of 50. When asked when to repeat the screening, 62% of GIF, 46% of 1-10 yr PGI, 51% of 1-20 yr PGI, and 31.1% of >20 yr PGI stated they would repeat at 10 years (P=0.013), and the rest preferred to repeat screening before 10 years. Conclusion: The difference in awareness of the 2008 ACG guidelines was not significant between the GIF and the PGI irrespective of the years in practice. Both GIF and PGI practices are in line with the guidelines when it comes to the age at which screening should start. However, PGI tend to advise re-scoping at shorter intervals than GIF, and this trend is more pronounced the longer the PGI is in practice.

2064 Endoscopic Protection from Left- versus Right-sided Colon Cancer

[2061]

Table 2. Upper GI X-ray results compared to 24-hour esophageal pH monitoring Normal pH probe results

Abnormal pH probe results

Normal upper GI X-ray results

18

22

Abnormal upper GI X-ray results

5

6

Am J Gastroenterol 2013; 108:S626–S652; doi:10.1038/ajg.2013.273

COLORECTAL CANCER PREVENTION 2062 Recognizing Jejunal Adenocarcinoma Alexander Kim, DO. Internal Medicine, Geisinger Medical Center, West Milton, PA. Purpose: Small bowel adenocarcinoma (SBA) is a rare cancer which consists less than 2.3% of gastrointestinal cancers. The rare nature of this malignancy led to a poor understanding of its pathogenesis and delays in diagnosis. With improved diagnostic imaging studies, there has been increasing reported cases of SBA in recent years. Due to its poor prognosis, it is imperative to recognize SBA as early as possible. Physicians also need to be more aware of SBA to recognize its signs and symptoms at the beginning stage of the disease. A 74-year-old woman with a significant family history of colon cancer presented with intractable nausea, vomiting, and diarrhea since 5 months ago. She denied weight loss, abdominal pain, and hematochezia. CT scan showed a partial small bowel obstruction. She was initially managed conservatively but her symptoms failed to improve. Upper GI series showed an area of narrowing in the proximal jejunum causing dilatation of the proximal jejunum. The etiology was uncertain and she underwent a diagnostic laparoscopy. There was a significantly dilated loop of small bowel and a focal inflammatory stricture in the distal jejunum. A partial small bowel resection was undertaken. The surgical pathology later revealed invasive, moderately differentiated, ulcerated adenocarcinoma with high grade dysplastic adenoma exhibiting transmural invasion into the mesentery of the descending colon. After the surgical resection of SBA, she was discharged from the hospital and there was an improvement in her symptoms. She had a follow-up visit after 2 years with a PET scan and there was no evidence of recurrent or residual disease. The typical presentation of SBA is often vague, including abdominal pain, nausea, vomiting, and weight loss. Our patient presented with vague symptoms and this potentially led to a delay in diagnosis and treatment. SBA is rare and frequently diagnosed at a late stage. It is often difficult to examine small bowel due to its location and tortuous anatomy. However, visualization of the small bowel in the last decade was improved by the introduction of capsule endoscopy and double balloon endoscopy. The American Cancer Society estimated 6,230 new cases and 1,110 deaths due to small bowel cancer in 2009 in the United States, and the incidence of SBA has been rising since. Physicians will need to be more aware of SBA and consider its possibility especially when elderly patients present with vague abdominal complaints. The appropriate diagnostic tools, such as capsule endoscopy and double balloon endoscopy, should be utilized to diagnose SBA early and to decrease mortality.

2063 Colon Cancer Screening: Guidelines or Gut Feelings Belen Tesfaye, MD,1 William Steinberg, MD, FACG,2 Eyasu Mekonen, MD,1 Angesom Kibreab, MD1. 1. Howard University Hospital, Washington, DC; 2. Rockville Internal Medicine Group, Rockville, MD. Purpose: To assess the current practice patterns of practicing gastroenterologists (PGI) and gastroenterology fellows (GIF) regarding screening patients with family history of colon cancer and to compare these practices to the 2008 ACG guidelines.

The American Journal of GASTROENTEROLOGY

Scott Rathgaber, MD, Yogita Fotaria, MD, Molly Meinen, BS BS. Gastroenterology, Gundersen Health System, La Crosse, WI. Purpose: Studies using large national and regional databases in multiple countries have suggested that endoscopy has a greater protective effect against left-sided colon cancer than right-sided cancer. We sought to determine if the protective effect of prior endoscopy was different for left vs right-sided colon cancer within our integrated health system. Methods: All patients diagnosed with primary colorectal adenocarcinoma between January 2006 and March 2013 were retrospectively reviewed. Patients were excluded if they had a history of inflammatory bowel disease, an inherited cancer syndrome, or age less than 50 years at diagnosis. Patients with transverse colon tumors were excluded. Staging and location of tumors were confirmed by pathologic examination of surgical specimens. Patients were categorized by left or right-sided cancer and by prior protective endoscopy within 6 months to 10 years before diagnosis or no prior protective endoscopy. Protective endoscopy was defined as colonoscopy completed to the cecum for right-sided cancer and colonoscopy or flexible sigmoidoscopy for left-sided cancer. Groups were analyzed for survival, stage, age, sex, and BMI. Comparison of the prevalence of right and left-sided cancers utilized Pearson’s chisquare test while comparison of tumor stage utilized the Mantel-Haenszel chi-square test. Survival curves were generated using the Kaplan-Meier method and survival times were compared using the log-rank test. Comparisons of BMI and age utilized the Student’s t-test. Results: 357 patients were included; 197 (55.2%) cancers were left-sided; 160 (44.8%) cancers were right-sided. 133 (31.6%) had a protective endoscopy. Fewer patients with left-sided cancer had a prior endoscopy than those with right-sided cancer (25.4% vs 39.4%, p50 years old who had not undergone screening colonoscopy, the most common reason was lack of time (55%), followed by distaste for the procedure (18%). When asked about preferred days for colonoscopy, 40.2% preferred weekdays, 26.8% weekends, and 33.0% answered “does not matter.” Conclusion: Our study indicates that compliance with screening colonoscopy among healthcare providers is slightly better than as reported for the general population, and definitely against the notion that healthcare providers are less compliant compared to the general population. Further education among healthcare providers is needed, and new strategies should be implemented to achieve better compliance with screening colonoscopy.

[2083]

Demographic characteristics of the respondents

Age Group (years)

Number of Respondents

Screening Colonoscopy

Gender

Profession

Positive Family History

Male

Female

Physician

Nurse

Medical Technician

Yes

No

40-49

39

15

24

12

19

8

6

4

35

50-59

47

29

18

19

18

10

4

28

19

60-69

24

14

10

10

8

6

4

21

3

> 70

2

1

1

2

0

0

0

2

0

Total

112

59

53

43

45

24

14

55

57

2082 Risk Factors for Colorectal Cancer in African Americans: Supporting the Rationale for Early Screening Sandar Linn, MD,1 Carmen Stanca, MD,2 Gregory Rozansky, MS III,1 Phillip Xiao, MD,3 Sury Anand, MD2. 1. Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY; 2. Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY; 3. Pathology, The Brooklyn Hospital Center, Brooklyn, NY. Purpose: African Americans have the highest colorectal cancer incidence and mortality rates in the U.S. with an earlier age at diagnosis. The distribution of colonic tumors is reported to be more right sided making screening colonoscopy the tool of choice in this population. This study looks at demographics and patterns of colon cancer in a typical inner city African American population. Methods: Adult patients who underwent surgery for colon cancer between 2004 and 2012 were enrolled in this retrospective study. We recorded demographics, tumor location and histology, and presence of metastases. Data were analyzed using SPSS; results are shown as median (range). Results: 640 subjects underwent surgery for colon cancer during the study period. 515 (81%) subjects were African American (AA) with 57% females. The median age at time of surgery was 67 (range 25-97). 61% of the AA group who underwent surgery were female compared to 42% in the White (W) group (p 10 mm

8;3

5;2

63%;67%

7;10

0;0

0%;0%

All Adenomas

18

14

78%

24

1

4.2%

2-5 mm

10

10

100%

9

1

11.1%

5-10 mm; > 10 mm

6;2

3;1

50%;50%

5;10

0

0%;0%

2085 Bi-annual Adenoma Detection Feedback Can Increase and Maintain a High Adenoma Detection Rate: A Community Group Study Shilun Li, MD,1 Joanne Maas, MS,1 Michael Spencer, PhD,2 Felicity Enders, PhD,3 Panagiotis Panagiotakis, MD,1 Meher Rahman, MD,1 David Brokl, MD1. 1. Gastroenterology and Hepatology, Mayo Clinic Health System, Mankato, MN; 2. Minnesota State University, Mankato, MN; 3. Mayo Clinic, Rochester, MN. Purpose: This study was designed to monitor the quality of colonoscopies at our institution. Every 6 months, we provided a colonoscopy quality report to each physician. Over the past 2.5 years, our group of four gastroenterologists has made gradual improvements in our adenoma detection rate (ADR) and increases in withdraw time. We postulated that periodic feedback of individual ADR can improve and maintain high quality colonoscopies at our institution. Methods: The platform of our endoscopy system is Olympus 180 series, high definition. Beginning in July 2010, our group has systematically been recording the scope insertion time, withdraw time, number of polyps, and pathology of polyps for every colonoscopy performed. The data were recorded manually in a Microsoft Excel spreadsheet. The pathology of the polyp(s) was recorded and matched to each colonoscopy report. A feedback report was provided to each physician every 6 months. Results: A total of 4,309 patients were examined during the 2.5-year study period, from 7/2010 to 12/2012. The average age of the participants was 59.4 years. The mean ADR for 3rd quarter 2010 was 49%, while the mean ADR for 4th quarter 2012 was 62%. The 13% increase in mean ADR was statistically significant (p