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⁎4505 Fecal occult blood testing - are we training medical students and residents well enough?
*4503 PREVALENCE AND RISK FACTORS FOR ADVANCED PROXIMAL COLONIC ADENOMAS IN AVERAGE-RISK POPULATION. Maite Betes, Miguel A. Martinez, Miguel A. Munoz-Navas, Susana De La Riva, Jose M. Duque, Maite Herraiz, Elena Macias, Ramon Angos, Jose C. Subtil, Elena Santamaria, Univ Clin OF NAVARRA, Pamplona, Spain. Aims: To establish independent predictive risk factors for APA in averagerisk population. Methods: From 1988 to 1998 screening total colonoscopy was performed in consecutive average-risk people, with strict exclusion criteria. Clinical, biochemical, endoscopic and histologic data were recorded. The term advanced was used for adenomas with villous component, moderate-severe dysplasia or ≥1cm. Adenomas were defined as distal if they came from the descending colon or distally. Univariate comparisons were assesed using the Chi2 Test and logistic regression. Backward stepwise logistic regression was used for multivariate analyses. Results: APA were detected in 125 of 2210 subjects (5.66%); 56 (44.8%) had no index distal adenoma. Independent predictors for presenting APA, after adjustment for the endoscopist who performed the endoscopy, are shown in the table. Conclusions: Almost half cases with APA did not present a distal index lesion. Distal polyp characteristics which were independent risk factors for APA were villous component and moderate-severe dysplasia.This multivariate model offers guidelines for clinicians in the approach to patients with distal tubular adenomas.
biopsied samples were made sure of containing all or part of the polyp, and then optimally sectioned. Results: The pressure on the polyp surface by the oral irrigator was almost same as that by maximum hand-spraying. Of 1381 resected polyps from 497 patients, 1235 polyps with a mean diameter of 4.1 mm were enrolled, excluding 41 of bad resected materials and 15 of difficulty to categorize as PDS+/-. With regard to the differentiation between adenomas and non-adenomas, PDS showed 97.4% and 97.1%; 92.8% and 92.6%; 96.7% and 96.5% of sensitivity, specificity and overall accuracy in small (<10 mm) and diminutive (<5 mm) polyps respectively. All polyps histopathologically diagnosed as severe atypia or carcinoma had been categorized as PDS+. Of 254 adenomas colonoscopically misdiagnosed as possible non-adenomas, 233 (91.7%) showed PDS+ meaning adenomas. Of 1021 adenomas, 63 (6.2%) were flat type in shape and 154 (15.0%) were only detected because of traumatic bleeding after PDS. Multiplicity rate were 73.5% of 249 adenoma-bearing patients. Average inspection time was 10min 57s, 13min 53s and 17min 30s in cases without resection, with one hot biopsy and with two hot biopsies respectively. Conclusions: CCC-PDS is suitable for colorectal cancer screening because 1) it is technically simple, 2) it is very effective in separating adenomas from non-adenomas, 3) it detects by traumatic bleeding adenomas that would otherwise be missed, 4) it have the possibility to detect much more adenomas including flat type than standard colonoscopy.
Independent predictive risk factors for APA in average-risk population N (2210) Age (yrs) 40-55 439 56-65 1291 >65 480 Sex Female 561 Male 1649 *Distal adenomas 0 1761 1 173 2 113 3 33 4 130
% APA
ADJUSTED OR
CI 95%
3.2 5.0 9.8
1 1.67 3.03
1.02-2.74 1.81-5.09
0.041 0.000
2.9 6.6
1 2.18
1.24-3.85
0.007
3.2 5.2 11.6 24.2 33.1
1 1.54 2.00 8.84 12.40
0.74-3.21 0.94-4.23 3.66-21.36 7.74-19.88
0.250 0.071 0.000 0.000
p
*0: no adenomas; 1: Tubular, ≤ 5mm, mild dysplasia; 2: Tubular, > 5mm, mild dysplasia; 3: Villous, mild dysplasia; 4: Moderate-severe dysplasia
*4504 COMPLETE CHROMO-COLONOSCOPY USING PRESSURE DYE SPRAY IS SUITABLE FOR COLORECTAL CANCER SCREENING. Toshinari Kanamori, Daiyukai Daiichi Hosp, Aichi, Japan. The usefulness of PDS to distinguish adenoma from non-adenoma has been reported in DDW 1999. In this report, it was reassessed by using another pump with about half output power of the previously reported one, and the suitability of CCC-PDS for colorectal cancer screening was evaluated. Methods: An oral irrigator equipped with a foot switch was used as a water pump. Dye solution containing 0.035% indigo carmine and 0.059% diethylpolysiloxane (anti-bubble) was sprayed using a cannula (Olympus PW-5V-1) throughout the entire colorectum after advancement of the scope (Olympus CF-Q240 or Q140) to the cecum. Once a polyp was recognized, a few times of spray jet application were focussed on the polyp at a distance of 1 to 2 cm. Any polyp showing no bleeding, petechiae, or bleeding without outflow was categorized as PDS-, and any polyp showing bleeding with outflow was categorized as PDS+. Under stereomicroscope, all resected specimens including hot
VOLUME 51, NO. 4, PART 2, 2000
*4505 FECAL OCCULT BLOOD TESTING - ARE WE TRAINING MEDICAL STUDENTS AND RESIDENTS WELL ENOUGH? A. Das, R. C. Wong, M. V. Sivak Jr., Univ Hospitals of Cleveland, Cleveland, OH. Training in colorectal cancer screening in general, and proper indications, techniques, interpretation and subsequent follow up of positive fecal occult blood testing (FOBT) in particular, should be integral to undergraduate and graduate medical education. In absence of objective data on how well informed medical students and residents are in the practical aspects of FOBT, we surveyed a cross section of medical students and residents in our institution. Methods: A questionnaire was administered to Internal Medicine residents and medical students rotating through inpatient medical service. The questionnaire consisted of two parts; part I was based on color slides of fecal occult blood tests which included both positive and false positive test cards. Questions in part II tested basic knowledge of indications, proper techniques, interpretation and recommended follow up of patients with positive test results. The questionnaire was based on the published guidelines of the American College of Physicians on FOBT. After administration of the questionnaire, the residents and medical students were instructed on practical aspects of FOBT and the questions were discussed with them in an interactive session. A subgroup of the residents and medical students were later retested on a similar questionnaire after 8 weeks. Results: Mean score out of a possible maximum score of 10 in medical students (n = 39), PGY1 (n = 31), PGY 2 (n = 10) and PGY 3 (n = 13) were 5.4 (0.2), 5.1(0.2), 5.8 (0.1) and 6 (0.1), respectively. By one way ANOVA when adjusted for the level of training there was no difference in mean score among different groups. Ten (10.8%) of participants were unable to correctly identify false positive FOBT cards. While 74 (79.6%) participants were unfamiliar with the correct techniques of performing FOBT, 78 (83.9%) did not know the recommended follow up of a positive FOBT. 83 (89.2%) recommended FOBT in an inappropriate clinical scenario. Interestingly, the subgroup of 31 residents and medical students who were retested after 8 weeks scored higher than their earlier performance (Mean score 4.9 (0.3) vs. 6.0 (0.3), p <0.01). Conclusions: Surprising gap of knowledge in the basic aspects of FOBT and colorectal cancer screening seems to exist among medical students and residents which does not improve during residency training. Demonstration of improved performance with didactic teaching calls for focussed training in FOBT and CRC screening.
GASTROINTESTINAL ENDOSCOPY
AB153
biopsied samples were made sure of containing all or part of the polyp, and then optimally sectioned. Results: The pressure on the polyp surface by the oral irrigator was almost same as that by maximum hand-spraying. Of 1381 resected polyps from 497 patients, 1235 polyps with a mean diameter of 4.1 mm were enrolled, excluding 41 of bad resected materials and 15 of difficulty to categorize as PDS+/-. With regard to the differentiation between adenomas and non-adenomas, PDS showed 97.4% and 97.1%; 92.8% and 92.6%; 96.7% and 96.5% of sensitivity, specificity and overall accuracy in small (<10 mm) and diminutive (<5 mm) polyps respectively. All polyps histopathologically diagnosed as severe atypia or carcinoma had been categorized as PDS+. Of 254 adenomas colonoscopically misdiagnosed as possible non-adenomas, 233 (91.7%) showed PDS+ meaning adenomas. Of 1021 adenomas, 63 (6.2%) were flat type in shape and 154 (15.0%) were only detected because of traumatic bleeding after PDS. Multiplicity rate were 73.5% of 249 adenoma-bearing patients. Average inspection time was 10min 57s, 13min 53s and 17min 30s in cases without resection, with one hot biopsy and with two hot biopsies respectively. Conclusions: CCC-PDS is suitable for colorectal cancer screening because 1) it is technically simple, 2) it is very effective in separating adenomas from non-adenomas, 3) it detects by traumatic bleeding adenomas that would otherwise be missed, 4) it have the possibility to detect much more adenomas including flat type than standard colonoscopy.
Independent predictive risk factors for APA in average-risk population N (2210) Age (yrs) 40-55 439 56-65 1291 >65 480 Sex Female 561 Male 1649 *Distal adenomas 0 1761 1 173 2 113 3 33 4 130
% APA
ADJUSTED OR
CI 95%
3.2 5.0 9.8
1 1.67 3.03
1.02-2.74 1.81-5.09
0.041 0.000
2.9 6.6
1 2.18
1.24-3.85
0.007
3.2 5.2 11.6 24.2 33.1
1 1.54 2.00 8.84 12.40
0.74-3.21 0.94-4.23 3.66-21.36 7.74-19.88
0.250 0.071 0.000 0.000
p
*0: no adenomas; 1: Tubular, ≤ 5mm, mild dysplasia; 2: Tubular, > 5mm, mild dysplasia; 3: Villous, mild dysplasia; 4: Moderate-severe dysplasia
*4504 COMPLETE CHROMO-COLONOSCOPY USING PRESSURE DYE SPRAY IS SUITABLE FOR COLORECTAL CANCER SCREENING. Toshinari Kanamori, Daiyukai Daiichi Hosp, Aichi, Japan. The usefulness of PDS to distinguish adenoma from non-adenoma has been reported in DDW 1999. In this report, it was reassessed by using another pump with about half output power of the previously reported one, and the suitability of CCC-PDS for colorectal cancer screening was evaluated. Methods: An oral irrigator equipped with a foot switch was used as a water pump. Dye solution containing 0.035% indigo carmine and 0.059% diethylpolysiloxane (anti-bubble) was sprayed using a cannula (Olympus PW-5V-1) throughout the entire colorectum after advancement of the scope (Olympus CF-Q240 or Q140) to the cecum. Once a polyp was recognized, a few times of spray jet application were focussed on the polyp at a distance of 1 to 2 cm. Any polyp showing no bleeding, petechiae, or bleeding without outflow was categorized as PDS-, and any polyp showing bleeding with outflow was categorized as PDS+. Under stereomicroscope, all resected specimens including hot
VOLUME 51, NO. 4, PART 2, 2000
*4505 FECAL OCCULT BLOOD TESTING - ARE WE TRAINING MEDICAL STUDENTS AND RESIDENTS WELL ENOUGH? A. Das, R. C. Wong, M. V. Sivak Jr., Univ Hospitals of Cleveland, Cleveland, OH. Training in colorectal cancer screening in general, and proper indications, techniques, interpretation and subsequent follow up of positive fecal occult blood testing (FOBT) in particular, should be integral to undergraduate and graduate medical education. In absence of objective data on how well informed medical students and residents are in the practical aspects of FOBT, we surveyed a cross section of medical students and residents in our institution. Methods: A questionnaire was administered to Internal Medicine residents and medical students rotating through inpatient medical service. The questionnaire consisted of two parts; part I was based on color slides of fecal occult blood tests which included both positive and false positive test cards. Questions in part II tested basic knowledge of indications, proper techniques, interpretation and recommended follow up of patients with positive test results. The questionnaire was based on the published guidelines of the American College of Physicians on FOBT. After administration of the questionnaire, the residents and medical students were instructed on practical aspects of FOBT and the questions were discussed with them in an interactive session. A subgroup of the residents and medical students were later retested on a similar questionnaire after 8 weeks. Results: Mean score out of a possible maximum score of 10 in medical students (n = 39), PGY1 (n = 31), PGY 2 (n = 10) and PGY 3 (n = 13) were 5.4 (0.2), 5.1(0.2), 5.8 (0.1) and 6 (0.1), respectively. By one way ANOVA when adjusted for the level of training there was no difference in mean score among different groups. Ten (10.8%) of participants were unable to correctly identify false positive FOBT cards. While 74 (79.6%) participants were unfamiliar with the correct techniques of performing FOBT, 78 (83.9%) did not know the recommended follow up of a positive FOBT. 83 (89.2%) recommended FOBT in an inappropriate clinical scenario. Interestingly, the subgroup of 31 residents and medical students who were retested after 8 weeks scored higher than their earlier performance (Mean score 4.9 (0.3) vs. 6.0 (0.3), p <0.01). Conclusions: Surprising gap of knowledge in the basic aspects of FOBT and colorectal cancer screening seems to exist among medical students and residents which does not improve during residency training. Demonstration of improved performance with didactic teaching calls for focussed training in FOBT and CRC screening.
GASTROINTESTINAL ENDOSCOPY
AB153