- Email: [email protected]
Ischemic colitis is commonest cause of lower GI bleed in a community practice
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Abstracts
Results: To date, there has not been a recurrent prolapse. No patient has complained of increased constipation. There have been no post operative complications. The mean post surgical length of stay was 5 days. The mean follow up has been, 9 months. Conclusions: This early data suggests that a sutureless rectopexy is a viable procedure, worthy of further investigation. The procedure may avoid complications that occur with a sutured rectopexy while retaining the advantages. 323 PHYSICIAN SELECTION OF COLORECTAL CANCER SCREENING METHODS IN AFRICAN-AMERICAN AND WHITE PATIENTS Marie L. Borum, M.D.*. The George Washington University, Washington, DC. Purpose: Colorectal cancer has significant morbidity and mortality in African-Americans. It has been recommended that physicians consider performing a colonoscopy for colorectal cancer screening in AfricanAmericans due to their increased risk for proximal colon lesions compared to other ethnic groups. However, there is evidence to suggest that AfricanAmericans may receive less colorectal cancer screening when compared to white patients. This study evaluated internal medicine physicians’ colorectal cancer screening practices and the selection of colorectal cancer screening methods for their African-American and white patients. Methods: A retrospective review of medical records was conducted to assess physicians’ adherence to colorectal cancer screening guidelines. During a 3 month period, consecutive patients ⱖ50 years of age who presented for a health maintenance evaluation were included in the study. Medical records were excluded if the patient had an increased risk for colorectal cancer or if the patient was evaluated for only a specific medical concern. Patients’ age, gender, race and physicians’ gender were obtained using a case report form. A database was developed with elimination of the patient name to ensure confidentiality. Univariate and multivariate statistical analyses were conducted. Statistical significance was assessed using Fischer’s exact test. Multivariate analysis using logistic regression was conducted to evaluate the independent variables. Results: One hundred seventy-seven (116 African-American, 61 white) patients were included in the study. Univariate analysis revealed a statistically significant difference (p⬍0.0001) in the rate at which physicians performed colonic examinations in African-American (26.7%) compared to white (100%) patients. However, when African-American patients were screened for colorectal cancer, they were statistically more likely (p⬍0.0001) to undergo a colonoscopy compared to white patients. Multivariate analysis revealed that patient race was the only factor that had an effect on colorectal cancer screening. Conclusions: This study revealed that physicians poorly adhered to colorectal cancer screening in African-American patients. However, physicians that adhered to colorectal cancer screening guidelines in African-Americans were more likely to offer colonoscopic screening to African-Americans compared to whites. Attention should be directed toward improving colorectal cancer screening in African-Americans and eliminating any racial disparity that may exist in health care delivery. 324 DOWNREGULATATION OF SYNDECAN-1 IN COLON CANCER CELLS: A POTENTIAL MECHANISM FOR ANTIPROLIFERATIVE AND ANTI-INVASIVE EFFECTS OF NSAIDS Nikhil Bhargava, D.O., Ramesh K. Wali, Ph.D., Jennifer Koetsier, B.S., Randall E. Brand, M.D., Hemant K. Roy, M.D.*. Evanston Northwestern Hospital–McGaw Medical Center, Evanston, IL. Purpose: Several lines of evidence suggest that nonsteroidal anti-inflammatory drugs (NSAIDS) may inhibit colorectal carcinogenesis. The mechanisms remain incompletely understood with multiple putative molecular targets. Syndecans are a family of cell surface transmembrane proteogly-
AJG – Vol. 98, No. 9, Suppl., 2003
cans which regulate cell proliferation, cell migration and angiogenesis, thereby acting as proto-oncogenes. Sydecan-1, in particular, has been shown to be a marker of poor prognosis in a wide variety of malignancies (i.e. prostate, lung, myeloma, cervical) potentially by imbuing the cancer with a more aggressive phenotype. Therefore, we hypothesized that NSAIDS would suppress syndecan-1 in colon cancer cells, leading to decreased proliferation and metastatic ability. Methods: Human colon adenocarcinoma cells, HCT-116, were grown in 6 well plates in McCoys 5A media supplemented with 10% fetal calf serum. After reaching 40% confluence, cells were treated with either the NSAID sulindac sulfide (0.1 mM) or the vehicle for 72 hours. The cells were harvested and syndecan-1 concentrations were determined using ELISA. Syndecan-1 levels were normalized to total protein as determined by bicinchoninic acid protein assay. Results: Sulindac sulfide treatment resulted in a 40% reduction in cell number as determined by MTT assay, associated with a suppression of cell proliferation (assessed through a decreased proliferative cell nuclear antigen (PCNA) expression). Syndecan-1 levels underwent a modest but statistically significant reduction with sulindac (to 80 ⫾20% of control, p⬍0.05).
Conclusions: We demonstrate, for the first time, that NSAID treatment suppressed syndecan-1 levels in colon cancer cell lines. The functional consequences of decreased syndecan-1 levels by sulindac may include anti-proliferative effects and possibly decreased metastatic ability. Future studies will be designed to explore the biological and clinical significance of these intriguing in vitro findings. 325 ISCHEMIC COLITIS IS COMMONEST CAUSE OF LOWER GI BLEED IN A COMMUNITY PRACTICE Kofi W. Nuako, M.D.*. TransSouth Healthcare, Union City, TN. Purpose: Diverticulosis and arteriovenous malformations are usually reported as the commonest causes of lower GI bleeding. The rate of ischemic colitis appears to be increasing for unclear reasons. This study explores the role of ischemic colitis in lower GI bleed in a community practice. Methods: A retrospective chart review of all patients with non-rectal lower GI bleed seen by a solo practitioner between 01/01/2002 and 01/01/2003 was conducted to document the contribution of ischemic colitis to causes of lower GI bleed. A total of 45 patients were identified. The diagnosis of ischemic colitis was confirmed by histologic findings. Results: Ischemic colitis was found to be the most common cause of lower GI bleed accounting for 26 cases (58%). Diverticulosis was the presumed source in 9 patients (20%); AVMs in 3 cases (7%); 2 cancers were identified. Upper GI source in 2 cases (4%) and unknown in 3 (7%). The mean age of the patients with ischemic colitis was 57.5 years (range 28-91) and 67% of them were women. All patients with ischemic colitis were
AJG – September, Suppl., 2003
Abstracts
taking medication but there was no obvious association with smoking (28%), IBS (17%) or constipation (9%). Causes of Lower GI Bleed Ischemic colitis Diverticulosis AVMs Upper GI Source Neoplasms Unknown
58% 20% 7% 4% 4% 7%
Hemorrhoidal bleeding excluded from study
Conclusions: Ischemic colitis is a very common cause of lower GI bleeding in a community practice. Further studies are warranted to evaluate the causes and optimal management of ischemic colitis in the community. 326 AN HISTORICAL PERSPECTIVE OF COLONOSCOPY AND POLYPECTOMY OVER THE PAST 30 YEARS Harvey W. Olsen, M.D.*. Oakland, CA. Purpose: The purpose of this study is to review a 30 year experience beginning with the early developement of colonoscopy and polypectomy in 2135 consecutive patients with polyps including patient follow-up. Methods: All patients with their first polyp identified at colonoscopy were consecutively entered into a large database beginning in 1972. Four physicians initially provided the patient data. The information obtained included demographic data, family history, findings at initial colonoscopy which included the location and pathology of polyps, the results of subsequent findings at colonoscopy and the eventual status of the patient. The data has been retrospectively analyzed to identify important correlations to improve future patient care. Results: A review of the patient data traces the improvements over the past 30 years in the techniques and technology of colonoscopy and polypectomy. Specific areas of focus include the improvements in the ability to complete colon examinations, increased safety, increased use for primary screening, the reduction in the incidence of missed polyps and cancer, and the demonstration that careful follow-up does prevent metachronous colon cancers. Conclusions: Our knowledge about colonoscopy and polypectomy has advanced greatly over the past 30 years. Our community experience supports the importance of present guidelines for colonoscopic screening and follow-up examination. 327 DOES PATIENT GENDER INFLUENCE PHYSICIANS’ COLORECTAL CANCER SCREENING PRACTICES? Marie L. Borum, M.D.*. The George Washington University, Washington, DC. Purpose: Colorectal cancer causes significant morbidity and mortality in the United States. While women and men are similarly affected by colorectal cancer, there is evidence to suggest that women may not receive adequate screening for this malignancy. This study evaluated internal medicine physicians’ screening practices in women and men. Methods: A retropsective medical record review evaluated physicians’ adherence to colorectal cancer screening recommendations based upon patients’ gender. During a 3 month period, consecutive patients ⱖ50 years of age who presented for a health maintenance evaluation and were at average risk for colorectal cancer were included in the study. The medical records were reviewed for patients’ age, gender and race. Physicians’ performance of rectal examinations, fecal occult blood testing, flexible sigmoidoscopy and colonoscopy was assessed. Univariate and multivariate statistical analyses were conducted. Statistical significance was assessed using Fischer’s exact test. Multivariate analysis using logistic regression was conducted.
S111
Results: There were 177 patients (120 women, 57 men) included in the study. Fifty-seven (47.5%) women and 29 (50.9%) men had rectal examinations. Fifty-six (46.7%) women and 30 (52.6%) men had fecal occult blood testing. Sixty (50%) women and 32 (56.1%) men had a flexible sigmoidoscopy or a colonoscopy performed. There was no significant difference in the rate at which rectal exams (p⫽0.1229), fecal occult blood testing (p⫽0.1075) or examinations of the colon (p⫽0.1070) were performed in women and men. Multivariate analysis revealed that only the patients’ race affected physicians’ adherence to colorectal cancer screening guidelines. There was a statistically significant difference in the rate at which African-American and white women received rectal examinations (p⫽0.0183), fecal occult blood testing (p⫽0.0055) and colonic examinations (p⬍0.0001). There was also a statistically significant difference in the rate at which African-American and white men received rectal examinations (p⫽0.0592), fecal occult blood testing (p⫽0.0327) and colonic examinations (p⬍0.0001). Conclusions: Physicians inconsistently adhered to colorectal cancer screening guidelines. There was no significant difference in colorectal cancer screening in women and men. However, patients’ race influenced colorectal cancer screening in both women and men. Efforts to improve physicians’ screening practices has the potential to decrease morbidity and mortality from colorectal cancer.
328 IDENTIFYING MALIGNANT AND PRE-MALIGNANT LESIONS IN AVERAGE-RISK INDIVIDUALS OF A PREDOMINANTLY AFRICAN AMERICAN AND HISPANIC POPULATION IN THE BRONX, NEW YORK Daniel S. Mishkin, M.D.C.M., Jonathan A. Erber, M.D., Daniel Gelrud, M.D., Morty Yalovsky, Ph.D., Lawrence J. Brandt, M.D., Douglas Simon, M.D.*. Montefiore Medical Center, Bronx, NY; Jacobi Medical Center, Bronx, NY and McGill University, Montreal, QC, Canada. Purpose: Screening colonoscopy is an accepted method to detect premalignant and malignant lesions in the colorectum. The purpose of this study was to address the prevalence and distribution of adenomas and cancers of the rectum and colon seen at screening examination in our unique ethnic population of the Bronx, for which there is a relative paucity of statistical information. Methods: A retrospective analysis was performed on all patients who underwent screening colonoscopies during 2002 in two inner-city teaching hospitals in the Bronx, NY: Jacobi Medical Center (JMC) and North Central Bronx (NCB). All patients were of average risk, i.e., age greater than 50 years; asymptomatic; and no family history of colorectal cancer. The study evaluated the location and histology of lesions in individuals self-identified as African American (AA), Hispanic, Caucasian, and Other. Results: Screening colonoscopies were performed in 440 patients. The group was 67 % female (n⫽294) and 33% male (n⫽145) with a mean age of 60.6 years . The group consisted of 50.2% Hispanic (n⫽221), 31.4% AA (n⫽138), and 5.7% Caucasian (n⫽25). Ninety patients (20.4%) had a pre-malignant or malignant lesion. Adenocarcinoma was discovered in 2 AA (1.4%) and 1 Hispanic (0.4%) patient, but in no Caucasians. Adenomas were present in 87 patients, of which 19 were ⱖ 1 cm; 54 (60%) had adenomas proximal to the splenic flexure. Only 9 (16.7%) patients with proximal lesions also had distal lesions. Subgroup analysis revealed no differences in numbers of lesions detected among ethnic groups (22.3% Hispanics, 18% AA, 16% Caucasians), with comparable age and sex distributions. An increased number of lesions were detected in males (30.3%) compared with females (15.5%) (p⬍0.005), for the Hispanic (32.9% male vs. 17.0% female; p⫽0.01) and AA (31.0% males vs. 12.5% female; p⫽0.01) groups. Conclusions: All ethnic groups in this population of AAs, Hispanics and Caucasians had a similar number and distribution of adenomas seen at colonoscopic screening examination. 60% of patients had adenomas located proximal to the splenic flexure. AA and Hispanic males were more
Abstracts
Results: To date, there has not been a recurrent prolapse. No patient has complained of increased constipation. There have been no post operative complications. The mean post surgical length of stay was 5 days. The mean follow up has been, 9 months. Conclusions: This early data suggests that a sutureless rectopexy is a viable procedure, worthy of further investigation. The procedure may avoid complications that occur with a sutured rectopexy while retaining the advantages. 323 PHYSICIAN SELECTION OF COLORECTAL CANCER SCREENING METHODS IN AFRICAN-AMERICAN AND WHITE PATIENTS Marie L. Borum, M.D.*. The George Washington University, Washington, DC. Purpose: Colorectal cancer has significant morbidity and mortality in African-Americans. It has been recommended that physicians consider performing a colonoscopy for colorectal cancer screening in AfricanAmericans due to their increased risk for proximal colon lesions compared to other ethnic groups. However, there is evidence to suggest that AfricanAmericans may receive less colorectal cancer screening when compared to white patients. This study evaluated internal medicine physicians’ colorectal cancer screening practices and the selection of colorectal cancer screening methods for their African-American and white patients. Methods: A retrospective review of medical records was conducted to assess physicians’ adherence to colorectal cancer screening guidelines. During a 3 month period, consecutive patients ⱖ50 years of age who presented for a health maintenance evaluation were included in the study. Medical records were excluded if the patient had an increased risk for colorectal cancer or if the patient was evaluated for only a specific medical concern. Patients’ age, gender, race and physicians’ gender were obtained using a case report form. A database was developed with elimination of the patient name to ensure confidentiality. Univariate and multivariate statistical analyses were conducted. Statistical significance was assessed using Fischer’s exact test. Multivariate analysis using logistic regression was conducted to evaluate the independent variables. Results: One hundred seventy-seven (116 African-American, 61 white) patients were included in the study. Univariate analysis revealed a statistically significant difference (p⬍0.0001) in the rate at which physicians performed colonic examinations in African-American (26.7%) compared to white (100%) patients. However, when African-American patients were screened for colorectal cancer, they were statistically more likely (p⬍0.0001) to undergo a colonoscopy compared to white patients. Multivariate analysis revealed that patient race was the only factor that had an effect on colorectal cancer screening. Conclusions: This study revealed that physicians poorly adhered to colorectal cancer screening in African-American patients. However, physicians that adhered to colorectal cancer screening guidelines in African-Americans were more likely to offer colonoscopic screening to African-Americans compared to whites. Attention should be directed toward improving colorectal cancer screening in African-Americans and eliminating any racial disparity that may exist in health care delivery. 324 DOWNREGULATATION OF SYNDECAN-1 IN COLON CANCER CELLS: A POTENTIAL MECHANISM FOR ANTIPROLIFERATIVE AND ANTI-INVASIVE EFFECTS OF NSAIDS Nikhil Bhargava, D.O., Ramesh K. Wali, Ph.D., Jennifer Koetsier, B.S., Randall E. Brand, M.D., Hemant K. Roy, M.D.*. Evanston Northwestern Hospital–McGaw Medical Center, Evanston, IL. Purpose: Several lines of evidence suggest that nonsteroidal anti-inflammatory drugs (NSAIDS) may inhibit colorectal carcinogenesis. The mechanisms remain incompletely understood with multiple putative molecular targets. Syndecans are a family of cell surface transmembrane proteogly-
AJG – Vol. 98, No. 9, Suppl., 2003
cans which regulate cell proliferation, cell migration and angiogenesis, thereby acting as proto-oncogenes. Sydecan-1, in particular, has been shown to be a marker of poor prognosis in a wide variety of malignancies (i.e. prostate, lung, myeloma, cervical) potentially by imbuing the cancer with a more aggressive phenotype. Therefore, we hypothesized that NSAIDS would suppress syndecan-1 in colon cancer cells, leading to decreased proliferation and metastatic ability. Methods: Human colon adenocarcinoma cells, HCT-116, were grown in 6 well plates in McCoys 5A media supplemented with 10% fetal calf serum. After reaching 40% confluence, cells were treated with either the NSAID sulindac sulfide (0.1 mM) or the vehicle for 72 hours. The cells were harvested and syndecan-1 concentrations were determined using ELISA. Syndecan-1 levels were normalized to total protein as determined by bicinchoninic acid protein assay. Results: Sulindac sulfide treatment resulted in a 40% reduction in cell number as determined by MTT assay, associated with a suppression of cell proliferation (assessed through a decreased proliferative cell nuclear antigen (PCNA) expression). Syndecan-1 levels underwent a modest but statistically significant reduction with sulindac (to 80 ⫾20% of control, p⬍0.05).
Conclusions: We demonstrate, for the first time, that NSAID treatment suppressed syndecan-1 levels in colon cancer cell lines. The functional consequences of decreased syndecan-1 levels by sulindac may include anti-proliferative effects and possibly decreased metastatic ability. Future studies will be designed to explore the biological and clinical significance of these intriguing in vitro findings. 325 ISCHEMIC COLITIS IS COMMONEST CAUSE OF LOWER GI BLEED IN A COMMUNITY PRACTICE Kofi W. Nuako, M.D.*. TransSouth Healthcare, Union City, TN. Purpose: Diverticulosis and arteriovenous malformations are usually reported as the commonest causes of lower GI bleeding. The rate of ischemic colitis appears to be increasing for unclear reasons. This study explores the role of ischemic colitis in lower GI bleed in a community practice. Methods: A retrospective chart review of all patients with non-rectal lower GI bleed seen by a solo practitioner between 01/01/2002 and 01/01/2003 was conducted to document the contribution of ischemic colitis to causes of lower GI bleed. A total of 45 patients were identified. The diagnosis of ischemic colitis was confirmed by histologic findings. Results: Ischemic colitis was found to be the most common cause of lower GI bleed accounting for 26 cases (58%). Diverticulosis was the presumed source in 9 patients (20%); AVMs in 3 cases (7%); 2 cancers were identified. Upper GI source in 2 cases (4%) and unknown in 3 (7%). The mean age of the patients with ischemic colitis was 57.5 years (range 28-91) and 67% of them were women. All patients with ischemic colitis were
AJG – September, Suppl., 2003
Abstracts
taking medication but there was no obvious association with smoking (28%), IBS (17%) or constipation (9%). Causes of Lower GI Bleed Ischemic colitis Diverticulosis AVMs Upper GI Source Neoplasms Unknown
58% 20% 7% 4% 4% 7%
Hemorrhoidal bleeding excluded from study
Conclusions: Ischemic colitis is a very common cause of lower GI bleeding in a community practice. Further studies are warranted to evaluate the causes and optimal management of ischemic colitis in the community. 326 AN HISTORICAL PERSPECTIVE OF COLONOSCOPY AND POLYPECTOMY OVER THE PAST 30 YEARS Harvey W. Olsen, M.D.*. Oakland, CA. Purpose: The purpose of this study is to review a 30 year experience beginning with the early developement of colonoscopy and polypectomy in 2135 consecutive patients with polyps including patient follow-up. Methods: All patients with their first polyp identified at colonoscopy were consecutively entered into a large database beginning in 1972. Four physicians initially provided the patient data. The information obtained included demographic data, family history, findings at initial colonoscopy which included the location and pathology of polyps, the results of subsequent findings at colonoscopy and the eventual status of the patient. The data has been retrospectively analyzed to identify important correlations to improve future patient care. Results: A review of the patient data traces the improvements over the past 30 years in the techniques and technology of colonoscopy and polypectomy. Specific areas of focus include the improvements in the ability to complete colon examinations, increased safety, increased use for primary screening, the reduction in the incidence of missed polyps and cancer, and the demonstration that careful follow-up does prevent metachronous colon cancers. Conclusions: Our knowledge about colonoscopy and polypectomy has advanced greatly over the past 30 years. Our community experience supports the importance of present guidelines for colonoscopic screening and follow-up examination. 327 DOES PATIENT GENDER INFLUENCE PHYSICIANS’ COLORECTAL CANCER SCREENING PRACTICES? Marie L. Borum, M.D.*. The George Washington University, Washington, DC. Purpose: Colorectal cancer causes significant morbidity and mortality in the United States. While women and men are similarly affected by colorectal cancer, there is evidence to suggest that women may not receive adequate screening for this malignancy. This study evaluated internal medicine physicians’ screening practices in women and men. Methods: A retropsective medical record review evaluated physicians’ adherence to colorectal cancer screening recommendations based upon patients’ gender. During a 3 month period, consecutive patients ⱖ50 years of age who presented for a health maintenance evaluation and were at average risk for colorectal cancer were included in the study. The medical records were reviewed for patients’ age, gender and race. Physicians’ performance of rectal examinations, fecal occult blood testing, flexible sigmoidoscopy and colonoscopy was assessed. Univariate and multivariate statistical analyses were conducted. Statistical significance was assessed using Fischer’s exact test. Multivariate analysis using logistic regression was conducted.
S111
Results: There were 177 patients (120 women, 57 men) included in the study. Fifty-seven (47.5%) women and 29 (50.9%) men had rectal examinations. Fifty-six (46.7%) women and 30 (52.6%) men had fecal occult blood testing. Sixty (50%) women and 32 (56.1%) men had a flexible sigmoidoscopy or a colonoscopy performed. There was no significant difference in the rate at which rectal exams (p⫽0.1229), fecal occult blood testing (p⫽0.1075) or examinations of the colon (p⫽0.1070) were performed in women and men. Multivariate analysis revealed that only the patients’ race affected physicians’ adherence to colorectal cancer screening guidelines. There was a statistically significant difference in the rate at which African-American and white women received rectal examinations (p⫽0.0183), fecal occult blood testing (p⫽0.0055) and colonic examinations (p⬍0.0001). There was also a statistically significant difference in the rate at which African-American and white men received rectal examinations (p⫽0.0592), fecal occult blood testing (p⫽0.0327) and colonic examinations (p⬍0.0001). Conclusions: Physicians inconsistently adhered to colorectal cancer screening guidelines. There was no significant difference in colorectal cancer screening in women and men. However, patients’ race influenced colorectal cancer screening in both women and men. Efforts to improve physicians’ screening practices has the potential to decrease morbidity and mortality from colorectal cancer.
328 IDENTIFYING MALIGNANT AND PRE-MALIGNANT LESIONS IN AVERAGE-RISK INDIVIDUALS OF A PREDOMINANTLY AFRICAN AMERICAN AND HISPANIC POPULATION IN THE BRONX, NEW YORK Daniel S. Mishkin, M.D.C.M., Jonathan A. Erber, M.D., Daniel Gelrud, M.D., Morty Yalovsky, Ph.D., Lawrence J. Brandt, M.D., Douglas Simon, M.D.*. Montefiore Medical Center, Bronx, NY; Jacobi Medical Center, Bronx, NY and McGill University, Montreal, QC, Canada. Purpose: Screening colonoscopy is an accepted method to detect premalignant and malignant lesions in the colorectum. The purpose of this study was to address the prevalence and distribution of adenomas and cancers of the rectum and colon seen at screening examination in our unique ethnic population of the Bronx, for which there is a relative paucity of statistical information. Methods: A retrospective analysis was performed on all patients who underwent screening colonoscopies during 2002 in two inner-city teaching hospitals in the Bronx, NY: Jacobi Medical Center (JMC) and North Central Bronx (NCB). All patients were of average risk, i.e., age greater than 50 years; asymptomatic; and no family history of colorectal cancer. The study evaluated the location and histology of lesions in individuals self-identified as African American (AA), Hispanic, Caucasian, and Other. Results: Screening colonoscopies were performed in 440 patients. The group was 67 % female (n⫽294) and 33% male (n⫽145) with a mean age of 60.6 years . The group consisted of 50.2% Hispanic (n⫽221), 31.4% AA (n⫽138), and 5.7% Caucasian (n⫽25). Ninety patients (20.4%) had a pre-malignant or malignant lesion. Adenocarcinoma was discovered in 2 AA (1.4%) and 1 Hispanic (0.4%) patient, but in no Caucasians. Adenomas were present in 87 patients, of which 19 were ⱖ 1 cm; 54 (60%) had adenomas proximal to the splenic flexure. Only 9 (16.7%) patients with proximal lesions also had distal lesions. Subgroup analysis revealed no differences in numbers of lesions detected among ethnic groups (22.3% Hispanics, 18% AA, 16% Caucasians), with comparable age and sex distributions. An increased number of lesions were detected in males (30.3%) compared with females (15.5%) (p⬍0.005), for the Hispanic (32.9% male vs. 17.0% female; p⫽0.01) and AA (31.0% males vs. 12.5% female; p⫽0.01) groups. Conclusions: All ethnic groups in this population of AAs, Hispanics and Caucasians had a similar number and distribution of adenomas seen at colonoscopic screening examination. 60% of patients had adenomas located proximal to the splenic flexure. AA and Hispanic males were more